三叉神经节经皮射频热凝术进针安全深度的解剖与CT对照研究

Comparative Study of Anatomy and CT Imaging on Puncture Safe Depth in Percutaneous Radio - frequency Thermocogulation of Trigeminal Ganglion

目的：探讨三叉神经节经皮射频热凝术（PRT）进针安全深度，为颅内进针避免损伤血管神经提供解剖学依据。方法：选择21例成人颅底解剖标本，用游标卡尺从颅内测量卵圆孔内侧缘中点至破裂孔外侧缘中点的距离（A）和卵圆孔内侧缘中点至三叉神经压迹上缘最高点的距离（B）；同时从颅外同一方向测量卵圆孔内侧缘至破裂孔外侧缘的距离（c）和破裂孔外侧壁垂直深度（D）；用螺旋CT扫描颅底，测量颅底水平位颅中窝最大密度投影（MIP）图像上同一方向卵圆孔内侧缘至破裂孔外侧缘的距离（E）。然后对距离c和安全距离及距离E进行统计分析，确定距离E是否可以作为指导不同患者进行PRT治疗时个体化的颅内安全进针深度。结果：①颅内卵圆孔内侧缘中点至破裂孔外侧缘中点的距离为右侧（1．19±0．15）cm，左侧（I．20±0．14）cm；②颅内卵圆孔内侧缘中点至三叉神经压迹顶点的距离为右侧（1．51±0．17）cm，左侧（1．49±0．16）cm；③颅外卵圆孔内侧缘中点至破裂孔外侧缘中点的距离为右侧（0．92±0．09cm），左侧（O．92±0．10）cm；④破裂孔外侧壁中点垂直深度为右侧（0．55±0．07）cm，左侧（0．55±0．07）cm；⑤中颅底水平位螺旋CT最大密度投影（MIP）图像上同一方向卵圆孔内侧缘中点至破裂孔外侧缘中点的距离为右侧（1．00±0．17）cm，左侧（1．00±0．17）cm，与距离C差异无统计学意义（P〉0．05）。结论：三叉神经节PRT治疗时颅内进针深度不应超过1．00Gm，临床上可用中颅底水平位螺旋CT最大密度投影（MIP）技术显示与相同方向卵圆孔内侧缘中点至破裂孔外侧缘中点的距离的一致性，来指导不同患者进行PRT治疗时个体化的颅内安全进针深度。

Objective： To explore puncture depth in pereutaneous radio - frequency thermocogulation of tri- geminal ganglion and provide anatomic basis to avoid intracranial puncture lesion of vessels and nerves. Methods ：21 cranial base specimens of the adult were selected. The distance between the midpoint of the medial border of the fora- men ovale and the midpoint of the lateral border of the foramen lacerum was measured by vernier caliper （A） and the distance between the midpoint of the medial border of the foramen ovale and the highest point of the superior margin of the trigeminal impression （B） on the internal surface of the cranial base specimens; At the same time , the distance between the medial border of the foramen ovale and the lateral border of the foramen lacerum at the same direction on the external surface of the cranial base specimens was measured （C） and the vertical diatance of the lateral wall of the foramen lacernm（D） scan horizontally the cranial base with spiral CT, then measure the distance between the medial border of the foramen ovale and the lateral border of the foramen lacernm at same direction on the maximum intensity projection（MIP） images（E） the distance C and the safe distance and the distance E was analyzed to deter- mine whether the distance E can be used to indicate the individual and safe needle depth into the skull at different pa- tients who were treated by PRT. Results： The distance between the midpoint of the medial border of the foramen ovale and the midpoint of the lateral border of the foramen lacernm on the internal surface of the cranial base specimens was 1.19 ± 0.15cm（ right） and 1.20 ± 0.14cm（left） ;②The distance between the midpoint of the medial border of the foramen ovale and the vertex of the trigeminal impression on the internal surface of the cranial base specimens was 1. 51 ± 0.17cm（ right） and 1.49 ± 0.16cm（left） ;③The distance between the midpoint of the medial border of the fora- men ovale and the midpoint of the lateral border of the foramen lacerum on the external surface of the cranial base specimens was 0.92 ± 0. 09cm（ fight） and 0.92 ±0.10cm（left） ;④The vertical distance of the lateral wall of the fo- ramen lacerum was 0.55 ± 0. 07cm（ right） and 0.55± 0.07cm （left） ; ⑤The distance between the midpoint of the medial border of the foramen ovale and the midpoint of the lateral border of the foramen lacernm at same direction on the maximum intensity projection（MIP） imaging was 1.00 ± 0.17cm（ right） and 1.00 ± 0.17cm（ left）, there was no statistical significance between the distance C and the distance E. Conclusions：The intractanial needle depth should be shorter than 1.00cm. In clinic we can display the accordance to the distance between the medial border of the fora- men ovale and the lateral border of the foramen lacernm at the same direction on the maximum intensity projection （MIP） imaging by scanning the cranial base horizontally with spiral CT, then use it to indicate the individual safe needle depth into the skull at different patients treated by PRT.