Observation Of Curative Effect Of Gamma Knife Radiosurgery With Localization Of 3.0T MRI And Double Targets For Trigeminal Neuralgia

Objective. To analyze the factor of effectiveness and complication with 3.0T MRI and double targets for trigeminal neuralgia of GKS.Methods. During Sep.2009 and Oct.2014, 55 patients were treated by Gamma knife radiosurgery with 3.0T MRI and double targets, 3D-TOF-SPER sequence and 3D-Fiesta sequence, and 1mm non-gap scanning were used for the localization. Image fusion were used to combine 1mm-thin layer’s cranial nerve scanned image and localization image to optimize dose planning. 4mm collimator were used. Two targets were set along the trifacial root near brain stem, central dose 90 Gy, dose to the brain stem surface was less than 16 Gy. For the patients taking second course of GKS, the target volume and the dose are diffrence to the first treatment.Result Follow-up time was 5 years, among 55 patients,(Improvements in facial pain were categorized according to the BNI pain intensity scale). pain relief(BNI-PⅠ,Ⅱand Ⅲa、b)in 52 patients(94.5%), 3 cases(5.5%) of pain recurrences were observed within 5 years. and Trigeminal nerve dysfunction was classified according to the BNI facial numbness scale.16 cases(29.1%)had numbness or paresthesias,in these patients,the trigeminal nerve dysfunction was severe in 3 patients.Conclusion. Double targets and clear image of trifacial nerve root showed with high field-intensity MRI is one of key factor to improve the effectness of GKS for trifacial neuralgia. GKS is a safe, effective approach in the treatment of trifacial neuralgia.And second treatment after the recrudescence is efficient, though more complications including facial numbness occur.