CT引导联合神经电生理测试射频热凝治疗原发性三叉神经痛156例疗效分析

Effects of radiofrequency thermocoagulation guided by CT-image combined with neurophysiological tests in the treatment of primary trigeminal neuralgia

目的探讨CT引导联合神经电生理测试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2013年5月至2014年1月中国医科大学附属第一医院疼痛科收治的156例原发性三叉神经痛患者,CT引导下按Hartel前入路法穿刺并结合神经电生理测试后行三叉神经半月节射频热凝术,损毁三叉神经相关感觉支,观察近期临床疗效并对中期疗效进行随访。结果 156例患者在CT引导下均可成功精确穿刺卵圆孔,结合电生理定位可精确做到选择性三叉神经半月节损毁。治疗后疼痛明显缓解,视觉模拟评分明显下降(P<0.05)。随访12个月有效率高达94.9%。6个月时复发5例,12个月时复发8例。结论 CT引导联合神经电生理试验能够精确定位卵圆孔及神经分支,射频热凝术能够安全、有效地治疗原发性三叉神经痛。

Objective To observe the clinical efficiency of radiofrequency thermocoagfulation （RFT）guided by CT-im- age combined with neurophysiological tests in the treatment of primary trigeminal neuralgia （PTN）. Methods A total of 156 cases hospitalized in our hospital from May 2013 to January 2014 with PTN were involved in this study. The direction and depth of foramen ovale were firstly made clearly after CT scan and punctured according to Hatel anterior approach. The direction and depth of puncture needle were adjusted by CT scan repeated and determined by the sensory or motor nerve response with neurophysiological tests. After successful puncturing oval foramen, RFT was performed to de- stroy sensory branch. Clinical efficacy and mid-term efficacy were assessed in follow-up. Results Selective and pre- cise damage of trigeminal nerve semilunar ganglion was achieved by neurophysiological tests. All cases had pain relief （P 〈 0.05）. Totally 156 cases were involved in the follow-up of 12 months after treatment, the efficiency rate being 94.9%. Five patients appeared to have no effects after 6 months. Eight patients relapsed after 12 months. Conclusion The anatomical depth of foramen ovale and nerve could be located precisely by CT-image combined with neurophysio- logical tests, and RFT could be safe and successful in treatment of PTN.