伽玛刀治疗原发性三叉神经痛长期随访疗效分析

目的分析伽玛刀治疗原发性三叉神经痛长期随访疗效、复发及并发症情况。方法回顾性分析142例应用伽玛刀治疗原发性三叉神经痛病人的临床资料,均行8年以上长期随访。采用巴罗神经学研究所（BNI）三叉神经痛评分标准对疗效进行评估,并总结长期疗效、复发及并发症情况。结果经长期随访,治疗达BNIⅠ-Ⅲ级134例,有效率94.4%,起效时间1-180 d;达BNIⅣ-Ⅴ级8例,治疗无效。复发24例（17.9%）,复发时间4-84个月。行2次治疗27例,治疗后有效率达85.2%。本组首次治疗后共发生并发症16例（11.3%）,大多数为一过性,随访期间逐渐消失。经统计学分析：有、无既往手术史的治疗后有效率差异显著（P〈0.05）,单、双靶点治疗和不同中心剂量的并发症发生率差异有统计学意义（P〈0.05）。结论伽玛刀治疗原发性三叉神经痛长期疗效良好,且具有术后复发率低、并发症轻微等优点,可作为治疗三叉神经痛首选方法之一。

Long-term follow-up and efficacy analysis of gamma knife radiosurgery for treating primary trigeminal neuralgia

Objective To analyze the long-team follow-up efficacy, reoccurrence and complications of gamma knife radiosurgery for primary trigeminal neuralgia. Methods Clinical data of 142 patients with primary trigeminal neuralgia undergoing gamma knife radiosurgery were analyzed retrospectively. Follow-up above 8 years was performed in all the patients. The efficacy assessed by Barrow Neurological Institute （BNI） pain scale, and long-term efficacy, reoccurrence, and complications were recorded. Results After long-team follow-up, BNI Ⅰ -Ⅲ were achieved in 134 patients, the efficacy rate was 94.4%, and the time of initial pain relieve was from 1 to 180 days. BNI Ⅳ-Ⅴ were in 8 cases, the treatment was invalid. The pain reoccurred in 24 patients （17.9%） and the time of reoccurrence was from 4 to 84 months. Twenty-seven patients were treated by the second gamma knife radiosurgery and the efficacy rate was 85.2%. The complications occurred in 16 patients （11.3%） and most complications were transient and gradually disappeared as time passed. There was efficiency significantly different between with or without previous surgery.treatment （P 〈 0.05）, and complication rate of single, dual-target treatment and the different centers dose difference was statistically significant （P 〈 0.05）. Conclusion Gamma knife treatment can be one of the first treatment options for primary trigeminal neuralgia, as its advantages including good results for long-term efficacy, low recurrence rate and mild complications.