- 立体定向放射外科治疗原发性三叉神经痛的临床研究
- 作者:吴承远|发布时间:2013-06-21|浏览量:1102次
立体定向放射外科治疗原发性三叉神经痛的临床研究
吴承远* 鲍修风 谭锋 杨立强 张岳松 王明席 李玉庆 朴京虎 赵耀巍 邵雷雷
[摘要] 目的 总结伽玛刀及射波刀治疗原发性三叉神经痛病例的治疗效果、起效时间和随访观察,以评价立体定向放射外科治疗原发性三叉神经痛的的临床效果。方法 总结27例三叉神经痛患者经伽玛刀治疗10例,经射波刀治疗17例。靶点选择在三叉神经根入桥脑段前3.0mm处, 伽玛刀采用4mm准直器, 50%剂量曲线限制靶区,中心剂量为75-80gy, 边缘剂量为37.5-40gy; 射波刀靶点大小为5mm*3mm-4mm*3.75mm, 照射靶区剂量66.66-84.21gy边缘剂量60-65gy。依据brisman疗效判定标准分析临床治疗效果。 结果 伽玛刀组10例随访时间5-12个月,治愈和疗效显著9例,1例无效,平均治疗一个月后起效;射波刀组17例随访时间6-21个月,治愈和疗效显著15例,无效2例。两组病例仅一例有面部麻木外无并发症。结论 立体定向放射外科(伽玛刀、射波刀)治疗原发性三叉神经痛具有可靠疗效。射波刀与伽玛刀相比较,前者无创无框架、非等中心、非共面、非聚焦照射为其优点,后者精度较高,定位更为准确。靶点选择和精确定位是立体定向放射外科治疗成功的关键所在。山东大学齐鲁医院神经外科吴承远
[关键词] 伽玛刀;射波刀;立体定向放射外科;原发性三叉神经痛
a clinical study of stereotactic radiosurgery for treatment of idiopathic trigeminal neuralgia
chengyuan wu*,xiufeng bao, feng tan, liqiang yang, yuesong zhang, mingxi wang,yuqing li, jinghu piao, yaowei zhao, leilei shao
[abstract]objective to evaluate the clinical outcomes, onset time of effect and follow-up of patients with idiopathic trigeminal neuralgia treated with gamma knife stereotactic radiosurgery (gksr) and cyberknife (ck) for assessing the clinical efficacy of stereotactic radiosurgery on idiopathic trigeminal neuralgia. methods the authors retrospectively reviewed the outcomes in twenty-seven patients with idiopathic trigeminal neuralgia who underwent gksr (10 patients) or ck (17 patients). the anatomical treatment targets were located at the proximal 3 mm of trigeminal nerve roots entering/emerging from the anterior pons. for the gksr group, a 4 mm collimator was applied to all patients. the tumors were in the 50% isodose curve. the maximal doses and the marginal doses prescribed were 75 to 80gy and 37.5 to 40gy respectively; for the ck group, the target sizes were 5mm*3mm to 4mm*3.75mm, the target doses and the marginal doses were 66.66 to 84.21gy, 60 to 65gy respectively. the clinical efficacy was assessed using brisman standards. results for the gksr group, the follow-up period ranged from 5 to 12 months. 9 patients achieved significant relief after a mean latency of one month, one patient had no improvement. for the ck group, the follow-up period ranged from 6 to 21 months. 15 patients achieved complete and significant relief, two patients had no improvement. only one patient was complicated with facial numbness in these two groups, no other side effect occurred. conclusions gksr and ck were effective in treating patients with idiopathic trigeminal neuralgia. compared with gksr, ck was frameless, noninvasive, non-coplanar and non-focal. treatment target selection and accurate location were crucial for the success of stereotactic radiosurgery.
[key words]gamma knife; cyberknife; stereotactic radiosurgery; idiopathic trigeminal neuralgia
作者单位:250022 济南,济南市106医院伽玛刀中心(谭锋、杨立强、张岳松、王明席、朴京虎、赵耀巍、邵雷雷);253600德州,乐陵人民医院神经外科(李玉庆);齐鲁医院神经外科(吴承远,鲍修风)
通讯作者:吴承远 250012 济南,山东大学齐鲁医院神经外科