| Objective:Disscussing the clinical effect of gamma knife(trigeminal neuralgia,TN)in the treatment of primary trigeminal neuralgia.Primary trigeminal neuralgia can be divided into primary trigeminal neuralgia with microvascular compression in the trigeminal nerve root and primary trigeminal neuralgia without microvascular compression in the trigeminal nerve root.In this experiment,we compared the efficacy of gamma knife treatment for two kinds of primary trigeminal neuralgia,and studied whether there was any differences in the therapeutic effect of the gamma-knife treatment for these two kinds of primary trigeminal neuralgia.It provides the database for the treatment plan of patients with primary trigeminal neuralgia,and better support for the clinical treatment.A total of 92 patients with primary trigeminal neuralgia treated with a voluntary head gamma knife were enrolled in the group.Methods: Collecting the clinical data of the patients with trigeminal neuralgia from January 2013 to December 2015 in the the Bethune International Peace Hospital.All patients were asked about the history of the disease in detail.MR scan and intensive 3D-TOF sequence examination of the head were performed to determine whether it was primary trigeminal neuralgia.A total of 92 voluntary patients with primary trigeminal neuralgia treated with head gamma knife were enrolled in the group.The patients with primary trigeminal neuralgia were divided into primary trigeminal neuralgia with microvascular compression in the trigeminal nerve root and primary trigeminal neuralgia without microvascular compression in the trigeminal nerve root according to 3D-TOF sequence results.The two groups were treated with the Leksell-C gamma knife.Two targets were intercalated along the trigeminal nerve in the two groups,and the two targets were located at the proximal pontine,After 24 months of follow-up,the curative effect was determined by Alpert’s pain classification method.The clinical efficacy of the two groups was evaluated.The age,sex,course characteristics and clinical efficacy of the two groups were compared,and the complications of the patients were recorded.The statistical software was used for data analysis to determine the difference in the clinical efficacy of the two groups.Results:1.A total of 92 patients with primary trigeminal neuralgia were enrolled.Among them,51 cases were primary trigeminal neuralgia with microvascular compression in the trigeminal nerve root,and 41 cases were primary trigeminal neuralgia without microvascular compression in the trigeminal nerve root.In the group of primary trigeminal neuralgia with microvascular compression in the trigeminal nerve root,32 were male and 19 were women.In the group of primary trigeminal neuralgia without microvascular compression in the trigeminal nerve root,27 were male and 14 were women.The mean course of primary trigeminal neuralgia with microvascular compression was(4.21±1.32)years,and the mean course of primary trigeminal neuralgia without microvascular compression was(4.76±1.45)years.The mean age of patients with primary trigeminal neuralgia with microvascular compression was(62.43±4.25)years.The mean age of patients with primary trigeminal neuralgia without microvascular compression was(65.26±5.13)years.The characteristics of the two groups were not statistically significant including sex,course of disease,age,and the follow-up time(P> 0.05).2.After 24 months of follow-up,the curative effect was determined by Alpert’s pain classification.21 cases of primary trigeminal neuralgia with microvascular compression were classified as grade I after treatment.13 cases classified as grade II,8 cases classified as grade III,5 cases classified as grade IV,4 cases classified as grade V 19 cases of primary trigeminal neuralgia without microvascular compression were classified as grade I after treatment.8 cases classified as grade II,7 cases classified as grade III,4 cases classified as grade IV,3 cases classified as grade V.3.The pain degree of all patients in the group before and 24 months after the gamma knife treatment was evaluated.Calculating the rate of cure、 efficiency and the incidence of complications.21 cases of primary trigeminal neuralgia with microvascular compression were cured after the head gamma knife treatment,and the cure rate was 41.2%.19 cases of primary trigeminal neuralgia without microvascular compression were cured after the head gamma knife treatment,and the cure rate was 46.3%.47 cases of primary trigeminal neuralgia with microvascular compression were effectively treated with head gamma knife,with an effective rate of 92.2%.38 patients with primary trigeminal neuralgia without microvascular compression were effective after the head gamma knife treatment,with an effective rate of 92.7%.five cases of patients with primary trigeminal neuralgia with microvascular compression were treated with facial numbness after the head gamma knife treatment.The incidence of complications was 9.8%.5 cases of patients with primary trigeminal neuralgia without microvascular compression were treated with facial numbness after the head gamma knife treatment.The incidence of complications was 12.2%.Statistical analysis showed that there was no signi-ficant difference in cure rate between primary trigeminal neuralgia with microvascular compression in the trigeminal nerve root and primary trigeminal neuralgia without microvascular compression in the trigeminal nerve root(P>0.05).There was no significant difference in effective rate between primary trigeminal neuralgia with microvascular compression in the trigeminal nerve root and primary trigeminal neuralgia without microvascular compression in the trigeminal nerve root(P>0.05).There was no significant difference in incidence rate of complications between primary trigeminal neuralgia with microvascular compression in the trigeminal nerve root and primary trigeminal neuralgia without microvascular compression in the trigeminal nerve root(P>0.05).Conclusions:1.Trigeminal neuralgia with microvascular compression and trigeminal neuralgia without trigeminal nerve roots are common in clinical trigeminal neuralgia.In this study,we followed up the patients with primary trigeminal neuralgia treated by gamma knife,and collected and counted the clinical data of patients.Anzlyzing the cure rate,efficiency and complication rate between the two groups statistically.This study suggests that the therapeutic effect of head gamma knife in the treatment of patients with primary trigeminal neuralgia is satisfactory.It have fewer complications and less adverse effects.2.Gamma knife has therapeutic effect on primary trigeminal neuralgia with microvascular compression and primary trigeminal neuralgia without microvascular compression,and there is no difference in therapeutic effect.3.Clinically,patients with primary trigeminal neuralgia can be treated with head gamma knife after cranial MR examination,whether or not microvascular compression is visible,and all patients can achieve satisfactory results.The head gamma knife has less trauma and fewer complications,and is very suitable for patients with primary trigeminal neuralgia that can not tolerate operation. |
