Stereotactic radiosurgery is an alternative to conventional surgery for the treatment of trigeminal neuralgia. The authors conducted a prospective evaluation of the safety and efficacy of this method in a large series of patients.
共有100名患者出现三叉neuralgia were treated and followed up for a minimum of 12 months. The mean age was 68.2 years; 54 patients were male, and 46 were female. Seven had a history of multiple sclerosis, and 42 had already received conventional surgical treatment for trigeminal neuralgia. The intervention consisted of gamma knife surgery to the retrogasserian cisternal portion of the fifth cranial nerve. The median dose used at the maximum was 85 Gy (range 70–90 Gy). The number and intensity of pain attacks were recorded by the patient from 3 months before radiosurgery to a minimum of 12 months after treatment. Before and a minimum of 12 months after treatment, the patient completed a quality-of-life questionnaire. Neurological examination and quantitative sensory testing to evaluate sensory perception were performed by an independent neurologist over this same time period.
At the last visit 83 of 100 patients were reported to be pain free. Fifty-eight of these 83 patients had stopped taking medication during the study. All quality-of-life parameters were improved (p < 0.001). Six patients reported facial paresthesia, and four patients reported hypesthesia. These symptoms were classified as mild. None of the complications reported for other techniques were observed.
Radiosurgery is a safe and effective alternative treatment for trigeminal neuralgia and is associated with a particularly low rate of hypesthesia.
BarkerFGII,,JannettaPJ,,BabuRP,,PomonisS,,BissonetteDJ,&Dong JhoH:Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors.J Neurosurg84:818–825,1996
BarkerFGII,,JannettaPJ,,BissonetteDJ,&JhoHD:Trigeminal numbness and tic relief after microvascular decompression for typical trigeminal neuralgia.开云体育app官方网站下载入口40:39–45,1997
BarkerFGII,,JannettaPJ,,BissonetteDJ,,LarkinsMV,&JhoHD:The long-term outcome of microvascular decompression for trigeminal neuralgia.N Engl J Med334:1077–1083,1996
BrismanR:Gamma knife radiosurgery for primary management for trigeminal neuralgia..J Neurosurg93:(Suppl 3)159–161,2000
BrismanR,,KhandjiAG,&MooijRB:Trigeminal nerve-blood vessel relationship as revealed by high-resolution magnetic resonance imaging and its effect on pain relief after gamma knife radio-surgery for trigeminal neuralgia.开云体育app官方网站下载入口50:1261–1267,2002
BroggiG,,FerroliP,,FranziniA,,ServelloD,&DonesI:Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis.J Neurol Neurosurg Psychiatry68:59–64,2000
BrownJA,,McDanielMD,&WeaverMT:Percutaneous trigeminal nerve compression for treatment of trigeminal neuralgia: results in 50 patients.开云体育app官方网站下载入口32:570–573,1993
ChangJW,,ChangJH,,ParkYG,&ChungSS:Gamma knife radio-surgery for idiopathic and secondary trigeminal neuralgia.J Neurosurg93:Suppl 3147–151,2000
De RidderD,,MollerA,,VerlooyJ,,CornelissenM,&De RidderL:Is the root entry/exit zone important in microvascular compression syndromes?.开云体育app官方网站下载入口51:427–434,2002
FlickingerJC,,PollockBE,,KondziolkaD,,PhuongLK,,FooteRL,&StaffordSL,et al.:Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery? A prospective double-blind, randomized study.Int J Radiat Oncol Biol Phys51:449–454,2001
FrighettoL,,De SallesAA,,SmithZA,,GossB,,SelchM,&SolbergT:Noninvasive linear accelerator radiosurgery as the primary treatment for trigeminal neuralgia.Neurology62:660–662,2004
GossBW,,FrighettoL,,DeSallesAA,,SmithZ,,SolbergT,&SelchM:Linear accelerator radiosurgery using 90 gray for essential trigeminal neuralgia: results and dose volume histogram analysis.开云体育app官方网站下载入口53:823–830,2003
HanPP,,ShetterAG,,SmithKA,,FiedlerJA,,RogersCL,&SpeiserB,et al.:伽玛刀放射治疗三叉神经痛: experience at the Barrow Neurological Institute.Stereotact Funct Neurosurg73:131–133,1999
Headache Classification Subcommittee of the International Headache Society:The international classification and diagnostic criteria for headache disorders, cranial neuralgia and facial pain, ed 2.Cephalalgia24:Suppl 19–160,2004
HuangE,,TehBS,,ZeckO,,WooSY,,LuHH,&ChiuJK,et al.:Gamma knife radiosurgery for treatment of trigeminal neuralgia in multiple sclerosis patients.Stereotact Funct Neurosurg79:44–50,2002
JawaharA,,KondziolkaD,,KanalE,,BissonetteDJ,&LunsfordLD:Imaging the trigeminal nerve and pons before and after surgical intervention for trigeminal neuralgia.开云体育app官方网站下载入口48:101–107,2001
KannanV,,DeopujariCE,,MisraBK,,ShettyPG,,ShroffMM,&PendseAM:Gamma-knife radiosurgery for trigeminal neuralgia.Australas Radiol43:339–341,1999
KannerAA,,NeymanG,,SuhJH,,WeinhousMS,,LeeSY,&BarnettGH:伽玛刀放射治疗三叉神经痛: comparing the use of a 4-mm versus concentric 4– and 8-mm collimators.Stereotact Funct Neurosurg82:49–57,2004
KanpolatY,,SavasA,,BekarA,&BerkC:Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience with 1,600 patients.开云体育app官方网站下载入口48:524–534,2001
KondziolkaD,,FlickingerJC,,LunsfordLD,&HabeckM:Trigeminal neuralgia radiosurgery: the University of Pittsburgh experience.Stereotact Funct Neurosurg66:Suppl 1343–348,1996
KondziolkaD,,LunsfordLD,&FlickingerJC:Gamma knife radio-surgery as the first surgery for trigeminal neuralgia.Stereotact Funct Neurosurg70:Suppl 1187–191,1998
KondziolkaD,,LunsfordLD,&FlickingerJC:Stereotactic radio-surgery for the treatment of trigeminal neuralgia.Clin J Pain18:42–47,2002
KondziolkaD,,LunsfordLD,,FlickingerJC,,YoungRF,,VermeulenS,&DumaCM,et al.:Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit.J Neurosurg84:940–945,1996
KondziolkaD,,LunsfordLD,,HabeckM,&FlickingerJC:伽玛刀放射治疗三叉神经痛.Neurosurg Clin N Am8:79–85,1997
KondziolkaD,,PerezB,,FlickingerJC,,HabeckM,&LunsfordLD:伽玛刀放射治疗三叉神经痛: results and expectations.Arch Neurol55:1524–1529,1998
KondziolkaD,,PerezB,,FlickingerJC,&LunsfordLD,伽玛刀放射治疗三叉神经痛.LunsfordLD,,KondziolkaD,&FlickingerJC:Progress in Neurological Surgery: Gamma Knife Brain SurgeryBasel,Karger,14:212–221,1998
LatchawJPJr,,HardyRWJr,,ForsytheSB,&CookAF:Trigeminal neuralgia treated by radiofrequency coagulation.J Neurosurg59:479–484,1983
LeksellL:Stereotaxic radiosurgery in trigeminal neuralgia.Acta Chir Scand137:311–314,1971
LeksellL:Stereotaxis and radiosurgery.An Operative SystemSpringfield, IL,Charles C Thomas,1971
LindquistC,,KihlstromL,&HellstrandE:Functional neurosurgery—a future for the gamma knife?.Stereotact Funct Neurosurg57:72–81,1991
LopezBC,,HamlynPJ,&ZakrzewskaJM:Stereotactic radiosurgery for primary trigeminal neuralgia: state of the evidence and recommendations for future reports.J Neurol Neurosurg Psychiatry75:1019–1024,2004
LopezBC,,HamlynPJ,&ZakrzewskaJM:烧蚀神经外科技术的系统评价ques for the treatment of trigeminal neuralgia.开云体育app官方网站下载入口54:973–983,2004
LoveS,&CoakhamHB:Trigeminal neuralgia: pathology and pathogenesis.Brain124:2347–2360,2001
LunsfordLD,&YoungRF:Radiosurgery for trigeminal neuralgia.Surg Neurol54:285–287,2000
MaesawaS,,SalameC,,FlickingerJC,,PirrisS,,KondziolkaD,&LunsfordLD:Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia.J Neurosurg94:14–20,2001
MaherCO,&PollockBE:Radiation induced vascular injury after stereotactic radiosurgery for trigeminal neuralgia: case report.Surg Neurol54:189–193,2000
MassagerN,,LorenzoniJ,,DevriendtD,,DesmedtF,,BrotchiJ,&LevivierM:Gamma knife surgery for idiopathic trigeminal neuralgia performed using a far-anterior cisternal target and a high dose of radiation.J Neurosurg100:597–605,2004
MatsudaS,,SerizawaT,,SatoM,&OnoJ:伽玛刀放射治疗三叉神经痛: the dry-eye complication.J Neurosurg97:5 Suppl525–528,2002
McLaughlinMR,,JannettaPJ,,ClydeBL,,SubachBR,,ComeyCH,&ResnickDK:Microvascular decompression of cranial nerves: lessons learned after 4400 operations.J Neurosurg90:1–8,1999
MehtaV,,MeierR,,GilreinJ,,VermeulenS,&YoungR:Gamma knife radiosurgery for treatment of trigeminal neuralgia.Int J Radiat Oncol Biol Phys57:2 SupplS136,2003
MerrisonAF,&FullerG:Treatment options for trigeminal neuralgia.BMJ327:1360–1361,2003
NicolB,,RegineWF,,CourtneyC,,MeigooniA,,SandersM,&YoungB:Gamma knife radiosurgery using 90 Gy for trigeminal neuralgia.J Neurosurg93:(Suppl 3)152–154,2000
NorthRB,,KiddDH,,PiantadosiS,&CarsonBS:Percutaneous ret-rogasserian glycerol rhizotomy. Predictors of success and failure in treatment of trigeminal neuralgia.J Neurosurg72:851–856,1990
NurmikkoT:Clinical features and pathophysiologic mechanisms of postherpetic neuralgia.Neurology45:12 Suppl 8S54–S55,1995
OturaiAB,,JensenK,,EriksenJ,&MadsenF:Neurosurgery for trigeminal neuralgia: comparison of alcohol block, neurectomy, and radiofrequency coagulation.Clin J Pain12:311–315,1996
PetitJH,,HermanJM,,NagdaS,,DiBiaseSJ,&ChinLS:Radiosurgical treatment of trigeminal neuralgia: evaluating quality of life and treatment outcomes.Int J Radiat Oncol Biol Phys56:1147–1153,2003
PollockBE,,PhuongLK,,FooteRL,,StaffordSL,&GormanDA:High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction.开云体育app官方网站下载入口49:58–64,2001
PollockBE,,PhuongLK,,GormanDA,,FooteRL,&StaffordSL:Stereotactic radiosurgery for idiopathic trigeminal neuralgia.J Neurosurg97:347–353,2002
RandRW:Leksell Gamma Knife treatment of tic douloureux.Neurosurg Clin N Am8:75–78,1997
RandRW,,JacquesDB,,MelbyeRW,,CopcuttBG,,LevenickMN,&FisherMR:Leksell Gamma Knife treatment of tic douloureux.Stereotact Funct Neurosurg61:Suppl 11–188,1993
RégisJ,,BartolomeiF,,MetellusP,,ReyM,,GentonP,&DravetC,et al.:Radiosurgery for trigeminal neuralgia and epilepsy.Neurosurg Clin N Am10:359–377,1999
RégisJ,,ManeraL,,DufourH,,PorcheronD,,SedanR,&PeragutJC:Effect of the Gamma Knife on trigeminal neuralgia.Stereotact Funct Neurosurg64:Suppl 1182–192,1995
RogersCL,,ShetterAG,,FiedlerJA,,SmithKA,,HanPP,&SpeiserBL:伽玛刀放射治疗三叉神经痛: the initial experience of The Barrow Neurological Institute.Int J Radiat Oncol Biol Phys47:1013–1019,2000
RogersCL,,ShetterAG,,PonceFA,,FiedlerJA,,SmithKA,&SpeiserBL:伽玛刀放射治疗三叉神经痛associated with multiple sclerosis.J Neurosurg97:5 Suppl529–532,2002
RomanelliP,,HeitG,,ChangSD,,MartinD,,PhamC,&AdlerJ:Cyberknife radiosurgery for trigeminal neuralgia.Stereotact Funct Neurosurg81:105–109,2003
ShetterAG,,RogersCL,,PonceF,,FiedlerJA,,SmithK,&SpeiserBL:Gamma knife radiosurgery for recurrent trigeminal neuralgia.J Neurosurg97:5 Suppl536–538,2002
SiegfriedJ:500 Percutaneous thermocoagulations of the Gasserian ganglion for trigeminal pain.Surg Neurol8:126–131,1977
SinayVJ,,BonamicoLH,&DubrovskyA:Subclinical sensory abnormalities in trigeminal neuralgia.Cephalalgia23:541–544,2003
SindouM,,KeravelY,,AbdennebiB,&SzapiroJ:Traitement neuro-chirurgical de la névralgie trigéminale.Neurochirurgie33:89–111,1987
SletteboH,,HirschbergH,&LindegaardKF:Long-term results after percutaneous retrogasserian glycerol rhizotomy in patients with trigeminal neuralgia.Acta Neurochir (Wien)122:231–235,1993
SmithZA,,De SallesAA,,FrighettoL,,GossB,,LeeSP,&SelchM,et al.:Dedicated linear accelerator radiosurgery for the treatment of trigeminal neuralgia.J Neurosurg99:511–516,2003
TaarnhojP:Decompression of the trigeminal root and the posterior part of the ganglion as treatment in trigeminal neuralgia; preliminary communication.J Neurosurg9:288–290,1952
UrgosikD,,VymazalJ,,VladykaV,&LiscakR:Gamma knife treatment of trigeminal neuralgia: clinical and electrophysiological study.Stereotact Funct Neurosurg70:Suppl 1200–209,1998
VerdugoR,&OchoaJL:Quantitative somatosensory thermotest.A key method for functional evaluation of small caliber afferent channels Brain115:Pt 3893–913,1992
VickreyBG,,HaysRD,,GraberJ,,RauschR,,EngelJJr,&BrookRH:A health-related quality of life instrument for patients evaluated for epilepsy surgery.Med Care30:299–319,1992
VickreyBG,,HaysRD,,RauschR,,EngelJJr,,VisscherBR,&AryCM,et al.:Outcome in 248 patients who had diagnostic evaluations for epilepsy surgery.Lancet346:1445–1449,1995
YarnitskyD,,KuninM,,BrikR,&SprecherE:Vibration reduces thermal pain in adjacent dermatomes.Pain69:75–77,1997
YoungRF:Functional neurosurgery with the Leksell Gamma knife.Stereotact Funct Neurosurg66:19–23,1996
YoungRF,,VermeulenS,&PosewitzA:Gamma knife radiosurgery for the treatment of trigeminal neuralgia.Stereotact Funct Neurosurg70:Suppl 1192–199,1998
YoungRF,,VermeulenSS,,GrimmP,,BlaskoJ,&PosewitzA:Gamma Knife radiosurgery for treatment of trigeminal neuralgia: idiopathic and tumor related.Neurology48:608–614,1997
ZakrzewskaJM,,JassimS,&BulmanJS:A prospective, longitudinal study on patients with trigeminal neuralgia who underwent radio-frequency thermocoagulation of the Gasserian ganglion.Pain79:51–58,1999
ZakrzewskaJM,&LopezBC:Quality of reporting in evaluations of surgical treatment of trigeminal neuralgia: recommendations for future reports.开云体育app官方网站下载入口53:110–122,2003
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