CT引导下立体定向射频热凝三叉神经半月节治疗原发性三叉神经痛的疗效观察

Efficacy of CT-Guided Stereotactic Semilunar Ganglion Radiofrequency Thermocoagulation in the Treatment of Primary Trigeminal Neuralgia

目的探讨CT引导下卵圆孔定位并立体定向穿刺射频热凝三叉神经半月节治疗原发性三叉神经痛的临床疗效。方法选取2008年10月—2011年11月在我院住院治疗的11例原发性三叉神经痛患者,均术前磁共振检查排除颅内病变。术前CT薄层扫描,通过Brain LAB手术计划系统确定患侧卵圆孔的三维坐标,在立体定向仪引导下穿刺患侧卵圆孔,根据疼痛分布范围射频热凝三叉神经半月节,并观察术后疗效。结果 11例患者均一次性穿刺成功,术中阻抗250～400Ω,平均289Ω。8例患者一次治愈。3例上颌支+眼支疼痛的患者治疗后上颌支的疼痛立即消失,1周内眼支分布区的疼痛也消失。所有患者触觉得以保留。3例患者在热凝过程中出现一过性血压增高,经过镇静和(或)让患者大声喊叫后可使其降至正常范围后继续治疗;2例术后由于紧张和血压升高等出现一过性眩晕,无其他重大不良反应。结论射频热凝术治疗原发性三叉神经痛效果的关键在于卵圆孔的准确定位,在CT引导和立体定向仪辅助下,卵圆孔穿刺准确率有所提高。

Objective To explore the value of CT- guided stereotactic foramen ovale localization and radiofrequency thermocoagulation on trigeminal semilunar ganglion in treating primary trigeminal neuralgia. Methods 11 patients with primary trigeminal neuralgia admitted to our hospital from October 2008 to November 2011 were selected and intracranial lesions were ex- cluded by preoperative MRI. Preoperative skull CT laminate scan was performed and Brain LAB surgical plan system was used to determine the three - dimensional coordinate of foramen ovale. The foramen ovale in the affected side was punctured by stereotac- tic technology and radiofrequency thermocoagulation was performed on trigeminal semilunar ganglion according to pain distribu- tion. Postoperative efficacy was then observed. Results 11 cases were punctured successfully for one time. The intra - opera- tive impedance was 250 - 400Ω with an average impedance of 289Ω. Eight cases were cured for one time. The maxillary neu- ralgia disappeared immediately and the ophthalmic neuralgia disappeared within one week in three cases with maxillary and oph- thalmic neuralgia after treatment. The sense of touch in all patients was preserved. Three cases had transient hypertension in the process of thermocoagulation but were reduced to normal level by sedation and shouting loudly before following up treatment. Two cases had transient dizziness due to nervousness and high blood pressure after operation. No other major adverse effect occurred. Conclusion The key for radiofrequency thermocoagulation in the treatment of primary trigeminal neuralgia is the location of fora- men ovale. With the aid of CT and stereotactic direction finder, the accuracy rate of foramen ovale puncturing has improved.