3D-CT引导下经眶-圆孔入路治疗三叉神经痛第Ⅱ支病变

3D-CT guided radiofrequency thermocoagulation through inferior orbital fissure and foramen rotundum approach in the treatment of V2 trigeminal neuralgia

目的:探讨3D-CT引导下经眶-圆孔入路行射频温控热凝治疗三叉神经痛第Ⅱ支病变临床应用价值。方法:选取30例三叉神经痛第Ⅱ支病变患者,采用经眶-圆孔入路,在三维CT引导下穿刺圆孔,定位成功后,神经电生理测试再次确认,行温控射频热凝治疗,观察术后临床疗效和并发症。结果:术后患者痛苦立即缓解,未见严重的并发症和其他神经损伤,术后第1年随访27例,有效率92.59%,1例复发,占3.70%。,除面部麻木外,无严重并发症。结论:3D-CT引导下经眶-圆孔入路射频热凝治疗三叉神经痛第Ⅱ支病变可提高穿刺成功率,降低并发症和周围神经损伤的发生率。

Objective： To observe the clinical effects of radiofrequency thermocoagulation （RFY） through inferior or- bital fissure and foramen rotundum approach in the treatment of the V2 trigeminal neuralgia, and to evaluate the efficiency and the safety of this study. Method： 30 patients with V2 trigeminal neuralgia were involved.CT scanning was given firstly t o evaluate the difficulty to puncture and determine the puncture path.The puncture point was in the inside of the junction of the lower orbital edge and the outer orbital edge.These patients passing through the evaluation were punctured under the CT guidance into foramen rotundum through inferior orbital fissure and then punctured to Gasserian ganglion as far as possible. Temperature-controlled radiofrequency therapy was conducted after puncture completed. Result： After the first evaluation with CT scan, 1 patient was excluded because puncture into foramen rotundum was considered too difficult and was punc- tured through Hatel approach, 27 cases were involved in the follow-up survey 1 year after treatment, the efficiency rate was 92.59 %, 1 patient recurred, the recurrence rate was 3.70 %.the pain relief rate and the efficiency rate gradually increased in the near future, no serious complications occurred. Conclusion： Guided by CT scanning, puncture through inferior orbital fissure and foramen rotundum approach can raise the success rate of puncture, enhance the safety and reduce the incidence of complication, showing high academic value and its promising future.