立体定向联合三维CT重建在三叉神经半月节射频热凝术中的应用

Application of stereotactic approach combined with 3D CT reconstruction in radiofrequency thermocoagulation of the trigeminal gasserian ganglion

目的 观察术前采用立体定向技术结合三维CT重建图像制定手术计划在三叉神经半月节射频热凝术治疗原发性三叉神经痛中的价值.方法 回顾性纳入2012年5月至2016年3月吉林大学中日联谊医院神经外科采用经皮穿刺三叉神经半月节射频热凝术治疗的原发性三叉神经痛患者,共30例.术前安装立体定向头框并行全颅三维CT重建检查,使用影像软件（Vitrea fX,Version 6.6.2）分析困难穿刺因素,制定术前手术计划.结果 30例患者均成功穿刺卵圆孔.其中困难穿刺因素＜2种的11例患者中,平均（1.4±0.7）次（1～3次）穿刺成功;困难穿刺因素≥2种的19例患者中,平均（2.6±0.9）次（1～5次）穿刺成功.术中X线验证穿刺针无弯曲的病例均1次穿刺成功.无一例患者发生严重的手术相关并发症.术后短期有效率为100％,1年有效率为96.7％ （29/30）;随访2年,复发4例（14.3％,4/28）,2年有效率为85.7％ （24/28）.结论 经皮三叉神经半月节射频热凝术前应用立体定向联合三维CT重建图像制定手术计划,定位准确性高,手术安全、有效,特别适用于卵圆孔穿刺困难的患者.

Objective To explore the role of stereotactic approach combined with surgical plan made by preoperative three-dimensional computed tomographic （3D CT） reconstruction in treatment of trigeminal neuralgia by percutaneous radiofrequency thermocoagulation of Gasserian Ganglion.Methods A retrospective analysis was conducted on 30 patients of trigeminal neuralgia who underwent percutaneous radiofrequency thermocoagulation of Gasserian Ganglion at Department of Neurosurgery,China-Japan Union Hospital of Jilin University,from May 2012 to March 2016.Stereotactic frame was installed and 3D CT reconstruction image was made prior to surgery.Image processing software （Vitrea fX,Version 6.6.2） was used to analyze difficult factors and make surgical plan.Results Foramen ovale puncture was successfully performed in all 30 patients.In the 11 cases with less than 2 difficult factors,an average of （1.4 ± 0.7,range：1-3） punctures were performed.In the remaining 19 cases with at least 2 difficult factors,an average of （2.6 ± 0.9,range：1-5） punctures were performed.All cases without bended puncture needles intraoperatively confirmed by fluoroscopy required only 1 puncture.No severe surgical complication occurred.The short-term and 1-year effective rates were 100% and 96.7% （29/30）,respectively.Four cases reported recurrence at 2-year follow-up with the recurrence rate of 14.3% （4/28）,and the 2-year effective rate was 85.7% （24/28）.Conclusion Percutaneous radiofrequency thermocoagulation of Gasserian Ganglion using surgical plan made by stereotactic approach combined with preoperative three-dimensional computed tomographic （3D CT） reconstruction could provide accurate localization,which seems to be safe and effective,particularly for cases with difficult-to-puncture foramen ovale.