神经导航联合电生理监测半月节射频治疗三叉神经痛

CLINICAL EFFICACY OF THE COMBINATION OF NERONAVIGATION AND ELECTROPHYSIOLOGICAL MONITORING TECHNIQUES PERCUTANEOUS RADIOFREQUENCY THERMOCOAGULATION THERAPY FOR THE TREATMENT OF TRIGEMINIAL NEURALGIA

目的：评估神经导航及电生理监测技术半月节温控射频术治疗三叉神经痛的临床疗效。方法：选取2013年4月至2014年3月间北京功能神经外科研究所收治的85例三叉神经痛（Trigeminal Neuralgia,TN）患者,应用神经导航系统进行头像重建,了解颅骨的基本形态,明确卵圆孔位置与角度和周边重要解剖结构并设置靶点及穿刺路径,联合电生理监测技术明确痛觉区域所在的三叉神经分支,行经皮半月节温控射频治疗,记录穿刺情况,并且记录穿刺及射频热凝术相关不良事件发生情况,利用视觉模拟评分（visual analogue scale,VAS）,口述疼痛缓解率（0%~100%）在术前和术后不同时间段（术后当天、术后一个月、术后3个月、术后6个月、术后12个月）对患者进行评估、比较分析,同时评估患者术后的面部麻木程度,评估此手术对TN治疗的临床特点及疗效。结果：85例患者在神经导航联合电生理监测下均顺利完成卵圆孔的穿刺,成功率为100%,根据术前诊断选择对应的三叉神经分支进行精确定位后行温控射频治疗,无一例患者发生穿刺相关不良事件如周围血管、神经损伤等。结论：神经导航联合电生理监测半月节射频治疗技术可极大提高卵圆孔的穿刺成功率,明确三叉神经的不同分支并进行精确定位,提高手术的安全性及疗效并降低手术并发症,表明此项技术具有很高的学术价值和临床应用前景。

Objective： To evaluate the efficiency and the value of percutaneous radiofrequency thermocoagulation（PRT） in treatment of primary trigeminal neuralgia through the combination of neuronavigation and electrophysiological technique. Methods： Collect all the 85 patients in our institution who were diagnosed primary trigeminal neuralgia between Apr. 2013 and Mar. 2014, and undergone percutaneous radiofrequency thermocoagulation therapy through the combination of neuronavigation and electrophysiological technique. In order to acquire the skull＇s three-dimensional reconstruction images, patients with TN had continuous and thinslice CT scans before surgery. The data will be transported to the neuronavigation equipment. Then written down the foramen ovale＇s information and around important nerves, vascular tissue, marked the target point and designed the best puncture path. Electrophysiological examination was used for determining the branch of the TN innervated. Visual analogue scale（VAS） and Verbal report pain relief（0% ~ 100%） were used before and after the surgery（the day after the surgery, one month later, 3 month, 6 month,12 month respectively）. Similarly, the facial numbness degree and the clinical features and efficacy were evaluated ate different time point after surgery. Results： All 85 patients were successfully punctured through the combined applicationof neuronavigation and electrophysiological technique with accurate positioning of the corresponding branch and PRT and no serious side-effect and complication.Conclusions： PRT through the combination of neuronavigation and electrophysiological technique can precisely position the different branches of trigeminal nerve and highly raise the success rate of puncture. In addition to this, the operation is a minimally invasive surgical method with little complication. Thus PRT through the combination of neuronavigation and electrophysiological monitoring technique is an safe, effective and reliable surgical option for the TN, showing high academic value and promising clinical application future.