CT引导经圆孔三叉神经射频热凝术三维穿刺路径及影响因素分析

CT-guided radiofrequency thermocoagulation of trigeminal nerve via foramen rotundum route:analysis of the three-dimensional puncture pathway and the influence factors

目的结合CT影像学测量,探究经圆孔穿刺的三维立体定位相关参数及性别、年龄、BMI指数对其影响,为提高穿刺成功率提供帮助。方法回顾性分析于2015年8月至2017年3月成功实施经圆孔穿刺治疗三叉神经痛(第2支)64例患者的CT图像。矢状面上,以患者外耳道开口至鼻根部连线(耳-鼻线)为基线,测量耳鼻线与穿刺针所成的夹角α。横断面上,测量穿刺针和鼻背中点与筛窦垂直板后缘中点连线(M线)所成的角度β,圆孔中点和穿刺进针点分别与M线的垂直距离为D_1和D_2,穿刺深度D_3。结果α的范围为44.10°~63.50°,平均55.05°±5.48°,β的范围为26.42°~68.37°,平均38.19°±8.58°。圆孔中点与M线的垂直距离D_1为(19.55±2.67)mm。体表穿刺点与M线的垂直距离D_2为(58.50±5.41)mm,穿刺深度D_3为平均(64.89±8.21)mm。不同性别,年龄,BMI值对穿刺角度,穿刺深度均有影响(P<0.05),而左右侧别则无统计学差异(P>0.05)。结论通过确定穿刺针α角及相关穿刺参数,可以大致确定圆孔穿刺三维立体空间方位,针对不同性别,年龄和BMI应对参数进行相应调整。

Objective Based on CT imaging measurements to investigate the relevant parameters of 3D positioning that are used for the puncturing of trigeminal nerve via foramen rotundum route, and to discuss the influences of gender, age, and BMI on the measurements of these parameters in order to improve the success rate of puncturing. Methods A total of 64 patients with trigeminal neuralgia（second branch）,who were successfully treated with CT-guided radiofrequency thermocoagulation of trigeminal nerve via foramen rotundum route during the period from August 2015 to March 2017, were included in this study.Their CT images were retrospectively analyzed. The line from the opening of the external auditory canal to the root of the nose（ear-nose line） was used as the base line on sagittal plane, and the angle between the earnose line and the puncture needle（angle α） was measured. On transverse section drawing a line between the midpoint of nose bridge and the midpoint of the posterior edge of the ethmoid sinus（M line）, the angle between M line and the puncture needle（angle β） was determined. The vertical distance from the midpoint of the foramen rotundum to M line（D_1）, the vertical distance from needle puncture point to M line（D_2）, and the puncture depth（D_3） were respectively measured. Results The angle α varied from 44.10° to 63.50° with a mean of（55.05°±5.48°）. The angle β ranged from 26.42° to 68.37° with an average of（38.19°±8.58°）. The distance of D_1 was（19.55±2.67） mm, the distance of D_2 was（58.50±5.41） mm, and the depth of D_3 was（64.89±8.21） mm. The gender, age and BMI value showed a close correlation with the puncture angle and the puncture depth（P〈0.05）, and no statistically significant differences in these indexes existed between the left side and the right side（P〈0.05）. Conclusion The angle α and the other puncture parameters can roughly determine the three dimensional spatial orientation of foramen rotundum, which can be further adjusted according to patient＇s gender, age and BMI value.