立体定向系统在卵圆孔穿刺治疗三叉神经痛中的应用

Application of stereotactic surgical planning system in foramen ovale puncture for the treatment of trigeminal neuralgia

目的探讨立体定向手术计划软件系统在经卵圆孔穿刺半月神经节射频热凝治疗原发性三叉神经痛的应用价值。方法收集2008年10月至2013年3月山东大学第二医院神经外科收治的原发性三叉神经痛患者共112例，通过立体定向技术进行经卵圆孔穿刺半月神经节射频热凝治疗三叉神经痛。与传统立体定向框架安装方法不同，本研究采用反装框架，将CT扫描dieom数据输入立体定向手术计划系统后行模拟穿刺，最终确定靶点坐标、经皮穿刺点坐标及穿刺路径。结果利用上述方法完成112例卵圆孔穿刺，术前经过立体定向手术计划系统修正穿刺路径25次（修正率为22．3％），路径设定后卵圆孔穿刺一次成功率为100％。无颈内动脉损伤出血、复视、角膜炎等并发症。即刻有效率为100％，1年有效率95．5％，2年有效率为90．2％。结论利用立体定向手术计划系统术前设定穿刺路径治疗三叉神经痛准确、安全、有效。

Objective To investigate the practical application value of stereotactic surgical planning system in the foramen ovale puncture for the treatment of idiopathic trigeminal neuralgia. Methods A total of 112 patients with trigeminal neuralgia admitted at the Department of Neurosurgery, the Second Hospital, Shandong University from October 2008 to March 2013 were enrolled. Using stereotaetie techniques to complete the radiofrequeney treatment of trigeminal neuralgia after foramen ovale puncture of gasserian ganglion. Different from the traditional mounting of the stereotactic frame, this study used reversed mounting frame. The simulation puncture was conducted after the CT scan dicom data were inputted into the stereotactic surgical planning system. The target coordinates, percutaneous puncture point coordinates, and puncture paths were ultimately determined. Results Using the above methods, 112 patients completed foramen ovale punctures. Twenty-five puncture paths were corrected by the stereotactic surgical planning system before procedure （ the correction rate was 22.3% ）. The one-time success rate of foramen ovale puncture was 100% after setting the paths. No serious complications occurred, such as internal carotid artery injury and bleeding, diplopia, and keratitis. The immediate effective rate was 100%, one-year effective rate was 95.5% %, and two-year effective rate was 90.2%. Conclusion Preoperative setting puncture paths using the stereotactic surffical planning system for the treatment of trieminal neuralaia is accurate, safe. and effective.