CyberKnife Radiosurgery for Refractory Trigeminal Neuralgia: A Single Institutional Experience

電腦刀放射線手術用於難治型三叉神經痛：單一機構經驗

丁瑋甄(Wei-Chen Ting) ； 楊清傑(Ching-Chieh Yang) ； 張進宏(Chin-Hung Chang) ； 陳泰源(Tai-Yuan Chen) ； 吳泰清(Tai-Ching Wu) ； 何秀雯(Hsiu-Wen Ho) ； 林立青(Li-Ching Lin)

《放射治療與腫瘤學》 24卷3期 (2017/09) Pp. 175-185

https://doi.org/10.6316/TRO/201724(3)175

摘要

Purpose : The purpose of this article is to evaluate the safety, efficacy, and side effects encountered in treating refractory trigeminal neuralgia (TN) using the CyberKnife radiosurgery (CKRS). Materials and Methods : Between March 2009 and October 2014, 22 patients with classical TN, refractory to previous medical or surgical treatments, received treatment at our CyberKnife center. The prescription dose of CKRS (range: 60-65 Gy) was delivered to the involved trigeminal nerve root entry zone with a 3-mm gap from the brainstem. Radiation dose to the brainstem was limited to 50% of the maximum dose or no more than 40 Gy. Treatment outcomes were assessed through telephone inquiries and scheduled follow-up visits. Treatment responses were addressed in a standard questionnaire containing the Barrow Neurologic Institute (BNI) pain score and facial numbness score. Results : The median duration of follow-up was 36 months. All patients responded to CKRS, as demonstrated by an improvement in their BNI pain scores. Median time to initial onset of pain relief was 7 days, and to maximal pain relief was 2 months. At the last follow-up, 13 patients (59%) were free from any pain (BNI I); 3 patients (14%) had occasional pain and no need of medication (BNI II), and 6 patients (27%) had moderate pain which was adequately controlled with medications (BNI III). Facial numbness was absent (BNI I) in 5 patients (23%), mild (BNI II) in 13 patients (59%), somewhat bothersome (BNI III) in 2 patients (9%), and very bothersome (BNI IV) in 2 patients (9%). Only 1 patient (4.5%) experienced pain relapse to the pre-CKRS status. Compared with other literatures, higher prescription doses and increased posttreatment numbness were not associated with better outcomes in this study. Conclusions : CKRS is an effective therapy for refractory trigeminal neuralgia. It provided high rates of pain control, early onset of pain relief, and few complications in our cohort.

關鍵字

CyberKnife ； Radiosurgery ； Trigeminal neuralgia

並列摘要

目的：這篇文章的目的在於評估電腦刀放射線手術用於治療難治型三叉神經痛的安全性、功效、和副作用。材料與方法：在 2009 年 3 月至 2014 年 10 月之間，有 22 位患有典型三叉神經痛的病人，對於之前的藥物或手術治療無效，在我們的電腦刀中心接受治療。電腦刀放射線手術的劑量（範圍：60-65 Gy）給予在三叉神經根和腦幹距離 3 mm 的地方。放射線在腦幹的劑量被限制在最大劑量的百分之 50 或小於 40 Gy。治療的結果經由電話詢問或是定期門診追蹤來評估。治療的反應則使用包含有 Barrow Neurologic Institute (BNI) 疼痛和臉麻分數的問卷來表示。結果：追蹤時間的中位數是 36 個月。全部的病人對於電腦刀放射線手術都有效果，可以從他們改善的 BNI 分數來證明。疼痛最初改善的時間中位數是 7 天，疼痛最大改善的時間中位數是 2個月。在最後追蹤的時候，有 13 個病人（59%）完全沒有任何疼痛（BNI I）；3 個病人（14%）偶爾感到疼痛但是不需要藥物（BNI II）；6 個病人（27%）有中度疼痛不過藥物能夠控制（BNIIII）。5 個病人（23%）完全沒有臉麻；13 個病人（59%）有輕微的臉麻；2 個病人（9%）有稍微惱人的臉麻；2 個病人（9%）有非常惱人的麻。只有 1 個病人（4.5%）的疼痛復發至電腦刀放射線手術前的狀態。和其他的文獻相比，此篇研究顯示處方劑量越高與治療後越麻和治療效果並無關連。結論：電腦刀放射線手術對於難治型三叉神經痛是一項有效的治療。在我們的病人中，它提供了高比例的疼痛控制，早期疼痛緩解，和很少的併發症。

並列關鍵字

電腦刀 ； 放射線手術 ； 三叉神經痛