颅外非半月节卵圆孔射频治疗三叉神经下颌支疼痛的疗效分析

Radiofrequency neurolysis in foramen ovale with extracranial non-semilunar ganglion for treatment of trigeminal neuralgia of mandibular branch

目的观察颅外非半月节卵圆孔射频热凝治疗三叉神经下颌支疼痛的临床效果。方法收集嘉兴市第一医院疼痛科自2016年1月至2017年12月收治的107例原发性三叉神经下颌支疼痛患者临床资料,所有患者均行CT引导下经皮穿刺卵圆孔射频热凝治疗。记录治疗过程中机架倾斜角度、穿刺角度与深度、穿刺操作时间,患者术中并发症及术后近、远期效果。结果107例患者均在CT定位引导下将射频穿刺针精准地穿刺至卵圆孔内、外口之间,机架倾斜角度(穿刺针与冠状面夹角)、穿刺角度(穿刺针与矢状面夹角)、平均穿刺深度和平均穿刺操作时间分别为(18.2±7.6)°、(15.9±4.6)°、(63.48±11.7) mm和(13.6±5.7) min。经90 ℃ 120 s射频热凝后104例患者下颌支支配区疼痛完全消失,针刺该区域感觉减退;2例患者耳前颞区残存疼痛,1例患者舌尖侧面遗留残余痛,再次射频后治愈。除21例患者术中出现面部血肿外,无颅内出血及感染发生。随访12~24个月,复发9例,再次治疗有效。结论选择颅外三叉神经下颌支出颅孔道(卵圆孔)行射频热凝治疗原发性三叉神经下颌支疼痛安全有效。

Objective To observe the clinical effect of extracranial radiofrequency thermocoagulation in foramen ovale on trigeminal neuralgia of mandibular branch. Methods The clinical data of 107 patients with primary trigeminal neuralgia of mandibular branch, admitted to our hospital from January 2016 to December 2017, were collected. With oxygen inhalation and vital signs monitoring, percutaneous radiofrequency thermocoagulation of foramen ovale was performed under CT guidance. The inclination angle, puncture angle and depth, puncture operation time, intra-operative complications, and short-term and long-term results after operation were observed. Results All patients were punctured to the inside and the outside foramen of foramen ovale precisely under the guidance of CT location, and the inclination angle (angle between the puncture needle and the coronal plane), puncture angle (angle between the puncture needle and the sagittal plane), average puncture depth and average puncture operation time were (18.2±7.6)°,(15.9±4.6)°,(63.48±11.7) mm and (13.6±5.7) min, respectively. The pain in mandibular branch dominant area disappeared completely in 104 patients after radiofrequency thermocoagulation at 90 ℃ 120 seconds, and the sensation of needling in this area decreased;two patients had residual pain in anterior ear and temporal area, and one patient had residual pain in lingual tip side, which was cured after radiofrequency treatment again. No intracranial hemorrhage and infection complications occurred except for 21 with facial hematoma during operation. Follow up for 12-24 months showed 9 were recurrence. Conclusion For patients with primary trigeminal neuralgia of mandibular branch, the target of radiofrequency therapy should be transferred from intracranial ganglion to extracranial trigeminal foramen (foramen ovale) for extracranial non-semilunar radiofrequency thermocoagulation therapy, which can obtain satisfactory results and improve the safety of radiofrequency therapy for trigeminal neuralgia.