经皮穿刺微球囊压迫术治疗三叉神经痛术中球囊容积与患者Meckel′s腔体积的相关性分析及对预后的影响

Correlation between balloon volume and Meckel′s cave size and its influence of percutaneous microballoon compression for trigeminal neuralgia

目的探讨经皮穿刺微球囊压迫术(PMC)治疗三叉神经痛术中球囊容积与患者Meckel′s腔体积的相关性以及压迫系数(即球囊容积/Meckel′s腔体积比值)对预后的影响。方法回顾性选取2018年2月至2020年10月在郑州大学第一附属医院接受全身麻醉下行PMC治疗三叉神经痛患者72例,其中男28例,女44例,年龄(62±11)岁。所有患者在术前均行颅脑磁共振成像(MRI)测量Meckel′s腔体积,在术中记录球囊容积,并计算压迫系数。在术前(T_(0))以及术后1 d(T_(1))、1个月(T_(2))、3个月(T_(3))、6个月(T_(4))通过门诊或电话等方式进行随访,记录并比较各时间点巴罗神经病学研究所疼痛量表(BNI-P)评分、巴罗神经病学研究所面部麻木(BNI-N)评分以及并发症发生情况。根据患者不同预后情况将患者分为3组:A组(n=48):患者疼痛未复发,且面部麻木程度轻;B组(n=19):患者疼痛未复发,但面部麻木严重;C组(n=5):患者疼痛复发。比较3组患者球囊容积、Meckel′s腔体积、压迫系数的差异,各组患者球囊容积与Meckel′s腔体积的相关性采用Pearson相关分析。结果PMC治疗三叉神经痛的有效率为93.1%(67/72)。T_(0)~T_(4)时间点,患者BNI-P评分M(Q_(1),Q_(3))分别为4.5(4.0,5.0)、1.0(1.0,1.0)、1.0(1.0,1.0)、1.0(1.0,1.0)和1.0(1.0,1.0)分,BNI-N评分M(Q_(1),Q_(3))分别为1.0(1.0,1.0)、4.0(3.0,4.0)、3.0(3.0,4.0)、3.0(2.0,4.0)和2.0(2.0,3.0)分;与T_(0)时比较,患者在T_(1)~T_(4)时BNI-P评分降低(均P<0.05),BNI-N评分增高(均P<0.05)。在总人群、A组、B组和C组中,患者球囊容积分别为(0.65±0.15)、(0.67±0.15)、(0.59±0.15)、(0.67±0.17)cm^(3),差异无统计学意义(P>0.05);患者Meckel′s腔体积分别为(0.42±0.12)、(0.44±0.11)、(0.32±0.07)、(0.57±0.11)cm^(3),差异有统计学意义(P<0.001);球囊容积与Meckel′s腔体积均呈线性正相关(r=0.852、0.924、0.937、0.969,均P<0.05)。A、B、C组患者压迫系数分别为(1.54±0.14)、(1.84±0.18)、(1.18±0.10),差异有统计学意义(P<0.001)。术中未出现死亡、复视、动静脉瘘、脑脊液漏和蛛网膜下腔出血等严重并发症。结论PMC治疗三叉神经痛术中球囊容积与患者Meckel′s腔体积呈线性正相关,不同预后患者的压迫系数不同,压迫系数可能是影响患者预后的因素。

Objective To investigate the correlation between balloon volume and Meckel's cave size during percutaneous puncture microballoon compression(PMC)for trigeminal neuralgia and the influence of the compression coefficient(the ratio of balloon volume/Meckel's cave size)on the prognosis.Methods Seventy-two patients(28 males and 44 females)aged(62±11)years who underwent PMC under general anesthesia for trigeminal neuralgia in the First Affiliated Hospital of Zhengzhou University from February 2018 to October 2020 were retrospectively collected.All patients underwent preoperative cranial magnetic resonance imaging(MRI)to measure Meckel's cave size,intraoperative balloon volume was recorded,and the compression coefficient was calculated.Follow-up visits were performed preoperatively(T_(0))and 1 d(T_(1)),1 month(T_(2)),3 months(T_(3)),and 6 months(T_(4))postoperatively,either in the outpatient clinic or by telephone,and the Barrow Neurological Institute pain scale(BNI-P)score,the Barrow Neurological Institute facial numbness(BNI-N)score and the occurrence of complications were recorded and compared at each time point.Patients were divided into 3 groups according to different prognoses:patients in group A(n=48)were with no recurrence of pain and mild facial numbness,patients in group B(n=19)were with no recurrence of pain but severe facial numbness,while those in group C(n=5)had recurrence of pain.The differences in balloon volume,Meckel's cave size,and compression coefficient were compared among the three groups,and the correlation between balloon volume and Meckel's cave size in each group was analyzed by Pearson correlation.Results The effective rate of PMC for trigeminal neuralgia was 93.1%(67/72).At time points from T_(0)to T_(4),patients had BNI-P scores[M(Q_(1),Q_(3))]of 4.5(4.0,5.0),1.0(1.0,1.0),1.0(1.0,1.0),1.0(1.0,1.0)and 1.0(1.0,1.0),and BNI-N scores[M(Q_(1),Q_(3))]of 1.0(1.0,1.0),4.0(3.0,4.0),3.0(3.0,4.0),3.0(2.0,4.0)and 2.0(2.0,3.0),respectively.Compared with those at T_(0),patients had lower BNI-P scores and higher BNI-N scores from T_(1)to T_(4)(all P<0.05).In all patients,group A,group B,and group C,the balloon volume was(0.65±0.15),(0.67±0.15),(0.59±0.15)and(0.67±0.17)cm^(3),respectively,with no statistically significant difference(P>0.05),while the Meckel's cave size was(0.42±0.12),(0.44±0.11),(0.32±0.07),and(0.57±0.11)cm^(3),with a statistically significant difference(P<0.001).The balloon volumes and Meckel's cave sizes were all linearly and positively correlated(r=0.852,0.924,0.937 and 0.969,all P<0.05).The compression coefficient in group A,B and C was(1.54±0.14),(1.84±0.18)and(1.18±0.10),respectively,with a statistically significant difference(P<0.001).There were no serious intraoperative complications such as death,diplopia,arteriovenous fistula,cerebrospinal fluid leak,and subarachnoid hemorrhage.Conclusions Intraoperative balloon volume during PMC for trigeminal neuralgia is linearly and positively correlated with the volume of the patient's Meckel's cave.The compression coefficient varies among patients with different prognoses and the compression coefficient may be a factor affecting the patient's prognosis.