应用电流感觉阈值定量检测三叉神经痛外科术后感觉功能

Using current perception threshold measurement for quantitative assessment sensory functions in surgical management of trigeminal neuralgia

目的手术导致的感觉功能障碍是三叉神经痛(trigeminal neuralgia,TN)外科治疗的主要临床并发症之一。本研究运用一种新近发展的感觉功能定量检测技术-电流感觉阈值测量法(current perception threshold measurement,CPTM)系统地识别和评定TN的三种主要外科手术后的三叉感觉功能。方法 48例无外科治疗史的TN患者接受了以下三种外科治疗中的一种:微血管减压术(microvascular decompression,MVD)、周围神经酒精阻滞术(peripheral nerve block,PNB)和经皮射频热凝术(percutaneous radiofrequency thermocoagulation,PRFT),术前48小时和术后4周进行CPTM和传统定性感觉功能检测。结果非手术侧未发现有统计学变化,证实CPTM的可重复性。PNB和PRFT在各CPTM检测频率上均发现存在显著的术后感觉功能障碍,表明所有三种感觉纤维均存在损害。另一方面,MVD术后所有三种纤维的感觉功能均未发生变化。结论 CPTM是一种用于评估经过外科治疗后的三叉神经感觉功能的定量、准确和可重复的方法。所检测的三种主要外科手术中,仅MVD保留了三叉神经的感觉功能。

Objective Sensory dysfunction due to surgical procedures is one of major clinical complaints following surgical treatment of trigeminal neuralgia.The goal of this project was to quantitatively identify and grade trigeminal sensory function after three major surgical procedures using quantitative sensory testing technique,the current perception threshold measurement.Methods In the current study,there were forty-eight trigeminal neuralgia patients without history of prior surgical treatment.These patients received one of the following three surgical treatments,microvascular decompression,peripheral nerve block with alcohol,or percutaneous radiofrequency thermocoagulation.The current perception threshold measurement and conventional qualitative sensory testing measurements were performed preoperatively and postoperatively to evaluate trigeminal sensory function.Each subject was his/her own control allowing comparison of the preoperative to postoperative state on the asymptomatic and symptomatic sides.Subjects were tested forty-eight hours preoperatively and four weeks postoperatively.Results Peripheral nerve block with alcohol and percutaneous thermocoagluation caused significant sensory dysfunction postoperatively at each current perception threshold measurement test frequency,indicating damage to all three fibers.On the contrary,the sensory function in all three fiber types was unchanged after microvascular decompression.Conclusion Among the three major surgical procedures tested,only microvascular decompression preserved sensory function in the trigeminal system.The advantage of the current study is the quantitative nature of the data.