选择性射频热凝治疗三叉神经痛1936例临床分析与手术技巧

CLINICAL EXPERIENCE AND SKILL OF SELECTIVE PERCUTANEOUS RADIOFREQUENCY THERMOCOAGULATION FOR THE TREATMENT OF TRIGEMINAL NEURALGIA OF 1936 CASES

目的 :总结 1936例选择性射频热凝治疗的三叉神经痛病例的经验和体会 ,探讨三叉神经痛射频热凝治疗的方法和技巧。方法 :分别进行眶上孔入路、眶下孔入路、侧入路或前入路卵圆孔射频热凝治疗。对Hartel前入路卵圆孔穿刺法进行改良。对 4 5例半月神经节定位困难的三叉神经痛病人 ,在射频热凝治疗术中应用X线、三维CT或导航进行卵圆孔定位或在术中验证靶点。结果 :术后即刻疗效 ,优良 15 2 8例 ,良好 336例 ,无疗效 72例 ,总有效率 96 .3%。 8个月～ 2年远期随访 10 97例 ,1年内复发 12 2例 ,复发率为 11.1% ,2年内复发 2 74例 ,复发率为 2 4 .9% ,无严重并发症。结论 :温控射频热凝治疗三叉神经痛疗效可靠 ,X线、三维CT及导航卵圆孔定位在一定程度上弥补了徒手穿刺的缺陷。

Objective: To summarize the experience of selective percutaneous radiofrequency thermocoagulation which was performed on 1936 cases with trigeminal neuralgia. Methods: Supraorbital foramen, infraorbital foramen and oval foramen radiofrequency thermocoagulation were performed on 1936 cases of trigeminal neuralgia. X ray, 3D CT and navigation oval foramen locations were used in 22, 19 and 4 patients respectively on intractable trigeminal neuralgia in order that the direction and position could be defined. Results: Pain has been eliminated in 1528 cases, alleviated in 336 cases. No changes were observed in 72 cases. No serious complications occurred in all of the patients. The effective rate is 96.3%. Conclusion: Selective percutaneous radiofrequency thermocoagulation is an effective way for the treatment of trigeminal neuralgia. X ray, 3D CT and navigation oval foramen locations can increase the successful rate of puncture, thus enhancing the safety and reducing the incidence rate of complications.