CT引导下立体定向射频热凝三叉神经半月节对原发性三叉神经痛的疗效分析

CT Neuronavigator-Guided Radio Frequency Thermocoagulation of Trigeminal Semi Lunar Ganglion to Treat Primary Trigeminal Neuralgia

目的:分析CT引导下立体定向射频热凝三叉神经半月节对原发性三叉神经痛的疗效,探讨其临床适用性。方法:选择从2011年5月至2012年12月于我院住院治疗原发性三叉神经痛的58例患者,在三维CT引导下采用通过Brain LAB手术计划系统经前入路卵圆孔穿刺三叉神经半月神经节,术中根据疼痛分布范围射频热凝三叉神经半月节。观察并比较治疗前后的VAS评分,临床疗效,术中和术后不良反应情况。结果:58例患者的穿刺手术均成功,术后1d、3d、6d的VAS评分均较治疗前显著降低(P<0.01);1周后58例患者中,有53例患者疼痛完全消失,1例患者偶然出现疼痛,但无需服用药物处理,共显效54例;4例患者疼痛有所减轻或疼痛发作频率降低,但仍需服用药物,或服用药物剂量较治疗前明显减少;疼痛无改善或者非用药不能缓解的持续痛仅1例。总有效例数为57例,总有效率达98.26%。术中发生不良反应6例,在术后均有所缓解。术后发生各种并发症共15例,均未明显影响手术效果。结论:CT引导可以较为准确的进入穿刺部位,使立体定向射频热凝三叉神经半月节手术更加顺利,达到治疗原发性三叉神经痛的理想效果,适合临床长期推广应用。

Objective： To analyze CT guided stereotactic radiofrequency thermocoagulation of trigeminal ganglion effect on pri- mary tfigeminal neuralgia, and to explore its clinical applicability. Methods： 58 cases with primary trigeminal neuralgia who were guided by 3D CT, Brain LAB operation system and anterior foramen ovale puncture trigeminal semilunar ganglion, intraoperative pain distribu- tion on radioi^equency thermocoagulation of trigeminal ganglion in our hospital fi＇om May 2011 to December 2012 were selected to be the objects. Then the clinical effect was observed and compared before and after treatment, the VAS score, adverse reaction and postop- erative situation were detected. Results： All the 58 cases have done a successful puncture operation. The postoperative 1D, 3D, 6D, VAS scores were significantly decreased （P〈0.01）; after the operation for one week, 53 patients＇ pain has disappeared completely, one reflected occasional pain but no need of medicine, 54 cases were markedly effective pain or pain frequency in 4 patients decreased, but still need to take drugs, or the drug dose was significantly lower than those before treatment; pain without improvement or persistent pain cannot alle- viate only in 1 cases. 57 cases were effective, the total effective rate was 98.26%. Intraoperative adverse reactions occurred in 6 cases, then were remiss. Various complications after the surgery were 15 cases, did not affect the operation effect. Conclusion： CT guide can be more accurate on the puncture site, and make stereotactic radiofrequency thermocoagulation of trigeminal ganglion operation more smoothly, and can achieve the ideal effect of the treatment of primary trigeminal neuralgia, thus is suitable for long-term clinical applica- tion.