微球囊压迫半月节治疗三叉神经痛临床疗效分析

Micro-balloon compression of trigeminal ganglion for the treatment of trigeminal neuralgia:clinical analysis of curative efficacy

目的总结分析经皮穿刺微球囊压迫术治疗原发性三叉神经痛的技术要点和临床效果。方法回顾性分析自2016年4月至2019年1月接受经皮穿刺微球囊压迫术治疗的53例三叉神经痛患者的临床资料。采用VRS、VAS-4和PPI疼痛量化表评估术后疗效和出院后的随访疗效。VAS≤10、VRS 0级或PPI 0级为疼痛完全缓解,VAS 10~40、VRS 1~2级或PPI 1~2级为疼痛满意缓解。结果本组患者疼痛受累最广泛的是上颌支,45例,术前疼痛病史20 d^32年,平均2.24年。7例曾接受过微球囊压迫术,2例曾接受过微血管减压术;术中球囊平均充盈容积0.702 mL,平均压迫时间125 s,3例术中发生球囊破裂。43例(81.1%)术后疼痛完全缓解,8例疼痛满意缓解,2例疼痛缓解不满意,总有效率为96.2%;术后患侧面部有麻木感50例(94.3%),咬肌乏力12例(22.6%),口周疱疹5例(9.4%),复视1例(1.9%),头痛5例(9.4%)。平均随访时间19.9个月;术后1年仍保持疼痛完全缓解者有30例(83.3%);至末次随访,本组整体的疼痛完全缓解率为71.7%(33例),疼痛满意缓解率24%(12例),总有效率95.7%;27例(57.4%)患者存在持续性的面部麻木感,其中6例麻木感严重影响日常生活并伴有同侧咬肌萎缩或面瘫。期间1例患者复发,之后又接受了2次球囊压迫术。结论经皮穿刺微球囊压迫术是治疗原发性三叉神经痛有效的微创手术方法,对于高龄体弱、不能耐受全麻手术或畏惧手术者更具有治疗优势,但也不能忽视伴发的严重的面部麻木感。

Objective To evaluate the clinical effect of percutaneous micro-balloon compression(PMC)of trigeminal ganglion in treating primary trigeminal neuralgia,and to discuss its technical key points.Methods The clinical data of 53 patients with trigeminal neuralgia,who received PMC treatment during the period from April 2016 to January 2019,were retrospectively analyzed.Using VRS,VAS-4 and PPI pain quantification table,the postoperative effect and follow-up effect after discharge were evaluated.VAS score of≤10 points,VRS of 0 grade or PPI of 0 grade were defined as total pain relief,and VAS score of 10-40 points,VRS of 1-2 grade or PPI of 1-2 grade were regarded as satisfactory relief of pain.Results In this group of patients,the maxillary branch of trigeminal nerve was the most commonly affected(n=45).The history of trigeminal neuralgia varied from 20 days to 32 years,with a mean of 2.24 years.Seven patients had received PMC treatment before,and 2 patients had undergone microvascuclar decompression(MVD)therapy.The intraoperative average balloon filling volume was 0.702 mL and the average compression time was 125 seconds.Intraoperative balloon rupture occurred in 3 patients.After PMC,complete pain relief was achieved in 43 patients(81.1%),satisfactory pain relief was obtained in 8 patients,poor relief of pain was seen in 2 patients,the total effective rate was 96.2%.Postoperative complications included facial numbness on the affected side(n=50,94.3%),weakness of masseter muscle(n=12,22.6%),perioral herpes(n=5,9.4%),diplopia(n=1,1.9%)and headache(n=5,9.4%).The mean follow-up time was 19.9 months.One year after PMC,complete pain relief was still maintained in 30 patients(83.3%).Until the last follow-up visit,in this series the overall complete pain relief rate was 71.7%(n=33)and the satisfactory pain relief rate was 24%(n=12),the total effective rate was 95.7%.Persistent facial numbness feeling existed in 27 patients(57.4%),in 6 of them the facial numbness feeling seriously affected their daily life,and at the same time these patients also suffered from masseter muscle atrophy or facial paralysis of the affected side.During the follow-up period,one patient had a recurrence and two times of PMC procedure had to be carried out.Conclusion For the treatment of trigeminal neuralgia,PMC is an effective minimally-invasive surgical method.PMC is suitable for the elderly and frail patients,especially for the patients who can’t tolerate the general anesthesia or who are afraid of surgery.PMC has certain therapeutic advantages,although the complication of severe facial numbness feeling cannot be ignored.