三叉神经节射频热凝术后大脑额叶、颞叶的功能变化

Changes of cerebral frontal and temporal lobes after trigeminal ganglion radiofrequency thermocoagulation

目的:探讨CT引导下采用三叉神经节经皮射频热凝术(percutaneous radiofrequency thermocoagulation,PRT)治疗原发性三叉神经痛(idiopathic trigeminal neuralgia,ITN)的临床疗效及患者脑功能变化。方法:选取安徽医科大学附属口腔医院及安徽医科大学第一附属医院收治的17例ITN患者为研究对象,在CT引导下进行PRT治疗。治疗前、后分别利用静息态功能磁共振成像(fMRI)方法检测脑功能变化。采用SPSS 16.0软件包,通过t检验和Pearson相关分析比较治疗前、后大脑比率低频振幅(f-ALFF)值变化、疼痛情况(VAS评分)、不良反应发生情况,以及相关脑区功能变化与临床指标间的相关性。结果:ITN患者在CT引导下进行PRT治疗后与治疗前比较,VAS评分显著降低(P<0.05),术后未发生明显不良反应;与疼痛相关的脑区(左侧额上回、右侧额上回,左侧额叶内侧皮质、右侧额叶内侧皮质、左侧颞下回)的fALFF值显著增强(P<0.001)。未发现相关脑区f-ALFF变化值与术后VAS变化及术后麻木之间具有显著相关性。结论:CT引导下进行PRT治疗,可缓解ITN患者疼痛,相关脑区f-ALFF值的变化对术后预后判断具有一定的参考价值。

PURPOSE:To explore the clinical effects of CT-guided trigeminal ganglion percutaneous radiofrequency thermocoagulation(PRT)on idiopathic trigeminal neuralgia(ITN)and patients’brain function changes.METHODS:Seventeen patients with ITN admitted to the Affiliated Stomatology Hospital of Anhui Medical University and the First Affiliated Hospital of Anhui Medical University were selected as study subjects.Brain function was detected by functional magnetic resonance imaging(fMRI)before and after CT-guided PRT surgery.SPSS 16.0 software was used to compare the changes in low-frequency amplitude(f-ALFF)value,pain condition(VAS score),adverse reaction,and related brain by t test and Pearson correlation analysis before and after treatment.RESULTS:Compared with pre-treatment,VAS score was significantly reduced(P<0.05),and no significant adverse reactions occurred after surgery.At the same time,the f-ALFF values of the left frontal gyrus,right frontal gyrus,left medial frontal cortex,right medial frontal cortex,and left inferior temporal gyrus were significantly enhanced(P<0.001).No significant correlation was found between f-ALFF changes in relevant brain areas and postoperative VAS changes and postoperative numbness.CONCLUSIONS:PRT treatment under CT-guidance can alleviate the pain of ITN patients,and it is safe and reliable.At the same time,the change of fALFF value in relevant brain regions provides a certain reference for the judgment of postoperative prognosis.