Long-term Efficacy And Safety Of Gamma Knife For Drug-refractory Trigeminal Neuralgia

Objective: To analyze the long-term efficacy and complications of Gamma Knife surgery(GKS)in patients with refractory trigeminal neuralgia,and to explore the prognostic factors.Methods: from January 2009 to September 2019,293 patients with trigeminal neuralgia who received gamma knife treatment for the first time in the gamma knife center of Radiotherapy Department of Affiliated Hospital of Inner Mongolia Medical University were studied retrospectively.Among them,10 patients recurred during the follow-up period and received gamma knife treatment again,a total of 303 radiotherapy.Univariate chi square test and multivariate logistic regression analysis were carried out around the radiation dose,neurovascular relationship,the course of trigeminal neuralgia,whether there was a history of intervention treatment in the past,whether there was a combination of clinical medical diseases and the basic information of patients such as gender,affected side,age,etc.Results: the total effective pain relief rate was 92.2%(270 / 293),the total complete pain relief rate was 66.2%(194 / 293),the incidence of facial numbness was 27.3%(80 / 293),and the recurrence rate was 5.8%(17 / 293).Among the patients who recurred,10 received gamma knife treatment again during the follow-up period.The effective pain relief rate was 100%(10 / 10)and the complete pain relief rate was 50%(5 / 10).The incidence of new facial numbness was 40.0%(4 / 10).In terms of efficacy: single factor and multi factor statistical analysis showed that the dose was positively correlated with the effective pain relief rate,and the effective time of high-dose group was significantly shortened.The adverse factors affecting the effective pain relief rate were the previous intervention and treatment history.In terms of recurrence rate,it was found that the recurrence rate of patients with a disease course of ≤ 5 years was lower than that of patients with a disease course of > 5 years;in terms of facial sensory dysfunction prescription The risk of facial numbness was significantly higher in the group of facial,vascular compression and the group with a history of intervention.Conclusion: gamma knife treatment of trigeminal neuralgia patients overall and long-term pain relief rate is high,less complications,safe and effective.The efficacy of repeated treatment is also positive.The higher treatment dose is the favorable factor for the curative effect and the effective time,while the patients with the previous intervention history and vascular compression of nerves are more likely to have the risk of facial sensory dysfunction.