CT引导下经皮穿刺卵圆孔行阿霉素阻滞治疗三叉神经痛

CT-guided percutaneous adriamycin injection blocking foramen ovale in the treatment of trigeminal neuralgia

目的探讨CT引导下经皮穿刺卵圆孔注射阿霉素毁损疗法治疗三叉神经痛的技术及临床应用价值.方法 63例三叉神经痛患者,男24例,女39例;年龄43～77岁,平均59岁.右侧疼痛41例,左侧22例.所有患者均有典型的三叉神经支配区域疼痛病史及服用苯妥英钠或卡马西平史,其中27例患者曾接受三叉神经周围分支化学毁损术,7例接受过半月神经节射频热凝毁损术,4例为微血管减压术后复发病例.结果 63例CT引导经皮穿刺卵圆孔全部引导成功.确定针尖在卵圆孔神经节内时,分次缓慢注射阿霉素0.2～0.5 ml.治疗后,即刻疼痛完全缓解者61例 (96.8%),明显缓解1例,轻度缓解1例.治疗后行6、12个月随访观察,有效率分别为84.1%,79.4%.并发症少而轻微,无严重并发症.结论 CT引导下经皮穿刺卵圆孔疗法对三叉神经痛具有定位准确,无痛苦,操作简单、安全,并发症少的优点,具有临床推广应用价值.

Objective To investigate the technique and clinical value of CT-guided percutaneous adriamycin injection blocking foramen ovale in the treatment of trigeminal neuralgia. Methods Sixty-three patients (24 males, 39 females; the age ranged from 43 to 77 years with a mean of 59) with trigeminal neuralgia were treated with percutaneous adriamycin injection by CT-guided foramen ovale blocking therapy. All the patients were diagnosed with typical symptoms and had been treated by medicine, and 38 of them were also treated by other operation approaches (27 by chemical medicine blocking, 7 by radiofrequency thermocoagulation, and 4 by microvascular decompression). Results All patients were successfully treated by CT-guided adriamycin blocking therapy. Adriamycin (0.2-0.5 ml) was slowly and fractionally injected when the tip was ascertained in ganglion of foramen ovale. Instant total pain relief was obtained in 61 cases (96.8%), obvious pain relief in 1 and slight relief in 1. After the initial procedure, pain relief rate at 6 and 12 months was 84.1% and 79.4%, respectively. No serious complications occurred. Conclusion CT-guided percutaneous foramen ovale blocking therapy was a precise, non-painful, highly effective, mini-traumatic, and safe treatment, and it was also an alternative treatment to classic technique.