CT与神经电生理联合引导射频热凝术治疗三叉神经痛(附100例报告)

Radiofrequency thermocoagulation under CT guidance combined with electrophysiology for trigeminal neuralgia: report of 100 cases

目的评价使用CT和神经电生理定位引导射频热凝术穿刺半月神经节治疗原发性三叉神经痛的临床价值。方法病人取仰卧位或坐卧位,采用Hartel前入路穿刺法,在CT颅底薄层扫描(行三维重建)引导下穿刺三叉神经半月神经节,并通过神经电生理电刺激确定电极针裸露段的准确位置,温控射频对靶点进行毁损,然后在麦氏囊内注射甘油0.3ml。结果均一次性穿刺进入卵圆孔,定位准确,在热凝毁损不同三叉神经感觉分支时未损伤其他脑神经。疼痛即刻消失,仅术区面部遗有麻木感,无其他严重并发症发生。结论颅底CT薄层扫描配合神经电生理定位,提高了卵圆孔穿刺的成功率和精确度,降低了并发症的发生率。

Objective To explore the clinical value of CT guidance combined with nerve electrophysiology in the radiofrequency thermocoagulation of Gasser＇s ganglion for the trigeminal neuralgia. Methods A hundred cases of trigeminal neuralgia were retrospectively analyzed. Gasser＇s ganglions were acupunctured under the intraoperative thin-section CT scan guidance via the Hartel＇s anterior facial approach in the supine or sitting positiom The accurate position of the exposed needle electrode was determined by electrophysiological test, the radiofrequency thermocoagulation then performed and 0.3 ml glycerin injected into the Meckel＇s sac finally. Results The needle was located accurately in oval foramen at the first puncture in all the cases, and the direction and position could be determined according to the electrophysiology test The sensory branches oftrigeminal nerve were thermocoagulated with no damage of other brain nerves. The pain was alleviated immediately after the operation with no serious complication except the face numbness. Conclusion Thin-section CT scan combined with electrophysiology in position of Gasser＇s ganglion can improve the success rate of foramen ovale puncture, enhance the safety and reduce the incidence rate ofcomplication.