三叉神経痛の定位放射線治療

Stereotactic Radiosurgery for Trigeminal Neuralgia

Point

・定位放射線治療は薬物治療困難かつ手術困難な患者（高齢，全身状態不良，手術拒否あるいは術後再発）が適応となる．

・手術と比較して効果はやや低く，副作用（感覚障害）の可能性が高い．

・短期の入院あるいは外来通院で治療可能な極めて低侵襲な治療である．

　Stereotactic radiosurgery（SRS）performed with Gamma Knife or CyberKnife has been reported to be effective in treating trigeminal neuralgia（TN）. Microvascular decompression is the first choice of treatment for patients with trigeminal neuralgia who are difficult to treat with drugs because of its high efficacy, with a pain relief rate of 70%-80% after 5 years. The pain relief rate of TN treated with SRS is approximately 50%-60% after 5 years, which is less than that of MVD. SRS is also inferior to surgery，causing more frequent sensory disturbances in the trigeminal nerve area（6%-20%）. However, the serious complications, severe morbidity and mortality, associated with SRS are quite rare. SRS is an extremely minimally invasive treatment that does not require general anesthesia and can be used to treat TN with short-term hospitalization or outpatient visits.