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山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (1): 28-33.doi: 10.6040/j.issn.1671-7554.0.2020.0686

• 临床医学 • 上一篇    下一篇

伽玛刀与微血管减压术治疗原发性三叉神经痛的疗效比较

王亮亮1,张铭1,孙振伟1,丁守銮2,樊跃飞1,王成伟1   

  1. 山东大学第二医院 1. 神经外科;2. 基础医学研究所循证医学中心, 山东 济南 250033
  • 发布日期:2021-01-09
  • 通讯作者: 王成伟. E-mail:wangchengwei@sdu.edu.cn

Comparison of efficacy of gamma knife radiosurgery and microvascular decompression in the treatment of primary trigeminal neuralgia

WANG Liangliang1, ZHANG Ming1, SUN Zhenwei1, DING Shouluan2, FAN Yuefei1, WANG Chengwei1   

  1. 1. Department of Neurosurgery;
    2. Center of Evidence-Based Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong, China
  • Published:2021-01-09

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摘要： 目的 伽玛刀放射治疗(GKS)和微血管减压术(MVD)是原发性三叉神经痛(PTN)的主要治疗方式,本研究比较两者的治疗效果和安全性。 方法 收集自2016年以来收治的76例PTN患者(GKS 40例,MVD 36例)治疗资料,并进行最长达40个月的随访,将收集的数据运用t检验、Wilcoxon符号秩和检验等统计学方法分析,评估两种治疗方式的疗效和并发症发生率。 结果 在GKS组和MVD组中,术前BNI与术后BNI分级的差异均有统计学意义(GKS:Z=-5.069,P<0.001;MVD:Z=-5.292,P<0.001)。GKS疼痛缓解的起效时间明显较MVD长［分别为(75.00±115.50)d、(2.00±0.00)d］,其差异有统计学意义(U=248.5,P<0.001),而且MVD患者疼痛缓解程度与GKS的差异有统计学意义(U=500,P=0.013)。MVD的并发症发生率(38.9%)高于GKS(20.0%),但两组间的差异无统计学意义(χ2=3.287,P=0.070)。两种治疗方式的花费差异有统计学意义［GKS(12 236±1 831)元,MVD(37 671±5 221)元,U=2.0,P<0.001］。 结论 GKS和MVD均为治疗三叉神经痛的有效措施,MVD可以获得即刻的疼痛缓解,其手术风险和花费均高于GKS治疗,而GKS是一种安全微创的治疗方式,患者需继续承受疼痛缓解之前的等待过程。因此对于PTN的治疗需要根据患者的具体情况制定个体化综合的治疗方案。

关键词: 伽玛刀, 微血管减压术, 三叉神经痛, 放射治疗

Abstract: Objective To compare the efficacy and safety of gamma knife surgery(GKS)and microvascular decompression(MVD)for primary trigeminal neuralgia(PTN). Methods A total of 76 patients with PTN were included in this study since 2016(GKS: 40 cases, MVD: 36 cases). The maximum follow-up lasted for 40 months. The efficacy and complication rate of the two treatment methods were evaluated with t-test and Wilcoxon signed rank sum test. Results The difference between preoperative and postoperative BNI was statistically significant(GKS: Z=-5.069, P<0.001; MVD: Z=-5.292, P<0.001). The pain relief effect time after GKS was significantly longer than that after MVD ［GKS:(75.00±115.50)days; MVD:(2.0±0.00)days］, and the difference was statistically significant(U=248.5, P<0.001). There was significant difference in the degree of pain relief between the MVD group and GKS group(U=500, P=0.013). The complication rate of MVD(38.9%)was higher than that of GKS(20.0%), but the difference was not statistically significant(χ2=3.287, P=0.070). There was statistically significant difference in the costs ［GKS:(12 236±1 831)yuan, MVD:(37 671±5 221)yuan, U=2.0, P<0.001］. Conclusion Both GKS and MVD are effective measures in the treatment of PTN. MVD can obtain immediate pain relief but it has higher surgical risks and costs than GKS. As a safe and minimally invasive treatment, GKS takes a long time for pain relief. Individualized, comprehensive treatment plans should be developed according to the specific conditions of patients.

Key words: Gamma knife, Microvascular decompression, Trigeminal neuralgia, Radiosurgery

中图分类号: 

  • R651.1+9
[1] Tuleasca C, Regis J, Sahgal A, et al. Stereotactic radiosurgery for trigeminal neuralgia: a systematic review [J]. J Neurosurg, 2018, 130(3): 733-757.
[2] Zeng Y, Zhang H, Yu S, et al. Efficacy and safety of microvascular decompression and gamma knife surgery treatments for patients with primary trigeminal neuralgia: a prospective study [J]. World Neurosurg, 2018, 116: e113-e117. doi: 10.1016/j.wenu.2018.04.120
[3] Ertiaei A, Ataeinezhad Z, Bitaraf M, et al. Application of an artificial neural network model for early outcome prediction of gamma knife radiosurgery in patients with trigeminal neuralgia and determining the relative importance of risk factors [J]. Clin Neurol Neurosurg, 2019, 179: 47-52. doi: 10.1016/j.clineuro.2018.11.007.
[4] Barker FG 2nd, Jannetta PJ, Bissonette DJ, et al. The long-term outcome of microvascular decompression for trigeminal neuralgia [J]. N Engl J Med, 1996, 334(17): 1077-1083.
[5] Sarsam Z, Garcia-Finana M, Nurmikko TJ, et al. The long-term outcome of microvascular decompression for trigeminal neuralgia [J]. Br J Neurosurg, 2010, 24(1): 18-25.
[6] Rogers CL, Shetter AG, Fiedler JA, et al. Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of the barrow neurological institute [J]. Int J Radiat Oncol Biol Phys, 2000, 47(4): 1013-1019.
[7] Sharma R, Phalak M, Katiyar V, et al. Microvascular decompression versus stereotactic radiosurgery as primary treatment modality for trigeminal neuralgia: a systematic review and meta-analysis of prospective comparative trials [J]. Neurol India, 2018, 66(3): 688-694.
[8] Brisman R. Microvascular decompression vs. gamma knife radiosurgery for typical trigeminal neuralgia: preliminary findings [J]. Stereotact Funct Neurosurg, 2007, 85(2-3): 94-98.
[9] Linskey ME, Ratanatharathorn V, Penagaricano J. A prospective cohort study of microvascular decompression and Gamma Knife surgery in patients with trigeminal neuralgia [J]. J Neurosurg, 2008, 109(Suppl): 160-172. doi:10.3171/JNS/2008/109/12/S25.
[10] Pollock BE, Schoeberl KA. Prospective comparison of posterior fossa exploration and stereotactic radiosurgery dorsal root entry zone target as primary surgery for patients with idiopathic trigeminal neuralgia [J]. Neurosurgery, 2010, 67(3): 633-638.
[11] Wang DD, Raygor KP, Cage TA, et al. Prospective comparison of long-term pain relief rates after first-time microvascular decompression and stereotactic radiosurgery for trigeminal neuralgia [J]. J Neurosurg, 2018, 128(1): 68-77.
[12] Berger I, Nayak N, Schuster J, et al. Microvascular decompression versus stereotactic radiosurgery for trigeminal neuralgia: a decision analysis [J]. Cureus, 2017, 9(1): e1000. doi:10.7759/cureus.1000.
[13] 欧阳禹权, 石涛涛, 魏俊怀, 等. 微血管减压术与伽玛刀治疗原发性三叉神经痛疗效的Meta分析[J]. 中国微侵袭神经外科杂志, 2020, 25(2):62-67. OUYANG Yuquan, SHI Taotao, WEI Junhuai, et al. Meta-analysis of the efficacy of microvascular decompression and gamma knife for primary trigeminal neuralgia [J]. Chinese Journal of Minimally Invasive Neurosurgery, 2020, 25(2): 62-67.
[14] Nanda A, Javalkar V, Zhang S, et al. Long term efficacy and patient satisfaction of microvascular decompression and gamma knife radiosurgery for trigeminal neuralgia [J]. J Clin Neurosci, 2015, 22(5): 818-822.
[15] Panczykowski DM, Jani RH, Hughes MA, et al. Development and evaluation of a preoperative trigeminal neuralgia scoring system to predict long-term outcome following microvascular decompression [J]. Neurosurgery, 2019, 87(1): 71-79
[16] Sindou M, Leston J, Decullier E, et al. Microvascular decompression for primary trigeminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression [J]. J Neurosurg, 2007, 107(6): 1144-1153.
[17] Miller JP, Magill ST, Acar F, et al. Predictors of long-term success after microvascular decompression for trigeminal neuralgia [J]. J Neurosurg, 2009, 110(4): 620-626.
[18] Inoue T, Hirai H, Shima A, et al. Long-term outcomes of microvascular decompression and Gamma Knife surgery for trigeminal neuralgia: a retrospective comparison study [J]. Acta Neurochir(Wien), 2017, 159(11): 2127-2135.
[19] Kondziolka D, Lunsford LD, Flickinger JC, et al. Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit [J]. J Neurosurg, 1996, 84(6): 940-945.
[20] Matsuda S, Serizawa T, Nagano O, et al. Comparison of the results of 2 targeting methods in Gamma Knife surgery for trigeminal neuralgia [J]. J Neurosurg, 2008, 109(Suppl): 185-189. doi:10.3171/JNS/2008/109/12/S28.
[21] Park SH, Hwang SK, Kang DH, et al. The retrogasserian zone versus dorsal root entry zone: comparison of two targeting techniques of gamma knife radiosurgery for trigeminal neuralgia [J]. Acta Neurochir(Wien), 2010, 152(7): 1165-1170.
[22] Xu Z, Schlesinger D, Moldovan K, et al. Impact of target location on the response of trigeminal neuralgia to stereotactic radiosurgery [J]. J Neurosurg, 2014, 120(3): 716-724.
[23] Zhao H, Shen Y, Yao D, et al. Outcomes of two-isocenter gamma knife radiosurgery for patients with typical trigeminal neuralgia: pain response and quality of life [J]. World Neurosurg, 2018, 109: e531-e538. doi: 10.1016/j.wneu.2017.10.014.
[24] Spina A, Boari N, Gagliardi F, et al. Gamma knife radiosurgery for trigeminal neuralgia: when? [J]. Neurosurg Rev, 2019, 42(2): 599-601.
[25] Regis J, Tuleasca C, Resseguier N, et al. Long-term safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study [J]. J Neurosurg, 2016, 124(4): 1079-1087.
[26] 王宏昭, 焦峻峰, 马琳, 等. 显微血管减压术与伽玛刀治疗老年原发性三叉神经痛近期疗效的对比分析 [J]. 中国微侵袭神经外科杂志, 2019, 24(7): 307-309. WANG Hongzhao, JIAO Junfeng, MA Lin, et al. Comparative analysis of the short term efficacy of microvascular decompression and gjamma knife in the treatment of eldly patients with idiopathic trigeminal neuralgia[J]. Chinese Journal of Minimally Invasive Neurosurgery, 2019, 24(7): 307-309.
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