放射外科生物有效剂量对特发性三叉神经痛 1 型的三叉神经根分割和切片疗效:一项多中心回顾性队列研究。

IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY
World neurosurgery Pub Date : 2025-01-01 Epub Date: 2024-11-14 DOI:10.1016/j.wneu.2024.10.084
Ke Tang, Nan Zhang, Xiaodong Yuan, Liangzhao Chu, Zenghui Qian, Yang Li
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引用次数: 0

摘要

目的:伽玛刀手术(GKS)治疗1型三叉神经痛(TN1)的疗效存在很大差异,这一点尚未完全阐明。我们旨在研究 TN1 的疗效与三叉神经根特定部位的放射手术生物有效剂量 (BED) 之间的关联:我们对 548 名接受 GKS 治疗的难治性 TN1 患者进行了多中心回顾性队列研究。对三叉神经根、受 TN1 影响的三叉神经根内负责分区(RD)、邻近根入口区的三叉神经根部分(S1)和脑干绘制了 BED-体积直方图,以生成最大 BED(DMaxBED),并以等效 BED 1000 Gy2.47 所占体积百分比(V%BED1000)作为计划质量指标。结果包括疼痛缓解、复发和并发症。采用逻辑回归和 Cox 比例危险模型分析 BED 参数:巴罗神经研究所(Barrow Neurological Institute,BNI)疼痛缓解等级在 1 个月内达到 III 级、复发和面部感觉减退的患者分别为 344 人(62.77%)、144 人(26.28%)和 54 人(9.85%)。患者层面的分析筛选出三叉神经根的 V%BED1000 与 1 个月内 BNI III 级和复发有关。脑干的 DMaxBED + S1 的 V%BED1000 可显著预测面部感觉减退。分区分析显示,DMaxBED + RD的V%BED1000可显著预测1个月内的BNI III级和复发:GKS治疗TN1的有效性和安全性可能取决于受疼痛影响的分区是否有足够的高BED覆盖,以及根进入区是否有可容忍的BED。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Radiosurgical Biologically Effective Dose on Trigeminal Root Division and Section for Outcomes of Idiopathic Trigeminal Neuralgia Type 1: A Multicentre Retrospective Cohort Study.

Objective: The wide variability in the efficacy of Gamma Knife surgery (GKS) treating trigeminal neuralgia type 1 (TN1) has not been completely elucidated. We aimed to investigate the association between outcomes of TN1 and the radiosurgical biologically effective dose (BED) on the specific part of the trigeminal root.

Methods: We performed a multicentre retrospective cohort study for 548 patients with refractory TN1 treated by GKS. BED-volume histogram was formed for the trigeminal root, responsible division within the trigeminal root affected by TN1, trigeminal root section adjacent to the root entry zone (S1) and brainstem to generate the maximum BED (DMaxBED), and the volume percentage enclosed by iso-BED 1000 Gy2.47 (V%BED1000) as plan quality metrics. The outcomes included pain relief, recurrence, and complications. Logistic regression and Cox proportional hazards models were used to analyse BED parameters.

Results: There were 344 (62.77%), 144 (26.28%), and 54 (9.85%) patients with Barrow Neurological Institute (BNI) pain relief class III within 1 month, recurrence, and facial hypoesthesia. Patient-level analysis screened V%BED1000 of the trigeminal root associated with BNI class III within 1 month and recurrence. DMaxBED of the brainstem + V%BED1000 of the S1 significantly predicted facial hypoesthesia. Division-level analysis showed that DMaxBED + V%BED1000 of the responsible division significantly predicted BNI class III within 1 month and recurrence.

Conclusions: The efficacy and safety of GKS treating TN1 may depend on the sufficient coverage of high BED on the division affected by pain and tolerated BED on the root entry zone.

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来源期刊
World neurosurgery
World neurosurgery CLINICAL NEUROLOGY-SURGERY
CiteScore
3.90
自引率
15.00%
发文量
1765
审稿时长
47 days
期刊介绍: World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
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