CT三维重建技术在经皮三叉神经半月节球囊压迫术中的应用

CT three-dimensional reconstruction in percutaneous balloon compression of the semilunar ganglion of trigeminal nerves

目的探讨CT三维重建技术在经皮三叉神经半月节球囊压迫术中的应用。方法山东大学齐鲁医院神经外科自2018年5月至2018年8月采用经皮三叉神经半月节球囊压迫术治疗三叉神经痛患者31例,所有患者术中均使用移动CT扫描并采用三维重建软件分析测量卵圆孔外口至岩骨脊的距离、穿刺针与岩骨脊及斜坡的夹角,记录患者术后即刻效果及随访10~12个月后预后情况。结果术中应用CT三维重建技术测得卵圆孔外口至岩骨脊的距离为(2.14±0.17)cm,范围为1.83~2.42 cm。穿刺针与岩骨脊的夹角为(102.03±7.60)°,范围为91.00~116.00°。穿刺针与斜坡的夹角为(68.03±7.06)°,范围为52.00~80.00°。在CT三维重建技术辅助下,31例患者卵圆孔均穿刺成功。术中球囊充盈体积为(0.42±0.05)cm^3,范围为0.30~0.47 cm^3;压迫时间为(4.72±0.53)min,范围为3.00~5.00 min。术后复视发生率为3.23%,眼睛干涩及角膜感觉减退症状发生率为12.90%。随访期间1例患者术后10个月复发,余患者均痊愈,并发症消失。结论应用CT三维重建技术可降低手术过程中卵圆孔穿刺难度,辅助术中球囊形状的判断及调整,提高手术疗效。

Objective To explore the CT three-dimensional reconstruction in percutaneous balloon compression of the semilunar ganglion of trigeminal nerves.Methods Thirty-one patients with trigeminal neuralgia,admitted to our hospital from May 2018 to August 2018,were treated by percutaneous balloon compression of the semilunar ganglion of trigeminal nerves.All patients underwent intraoperative mobile CT scan;the distance from the external aperture of foramen ovale to the petrous ridge,the angle from puncture needle and the petrous ridge,and the angle from puncture needle and the clivus were analyzed by three-dimensional reconstruction technology.Prognoses were recorded immediately after surgery and 10-12 months after follow-up.Results The distance from the external aperture of foramen ovale to the petrous ridgea was(2.14±0.17)cm,ranged from 1.83 cm to 2.42 cm.The angle from puncture needle and the petrous ridge was(102.03±7.60)°,ranged from 91.00°to 116.00°.The angle from puncture needle to the clivus was(68.03±7.06)°,ranged from 52.00°to 80.00°.The puncture succeeded in all patients under the help of CT three-dimensional reconstruction.The volume of the inflated balloon ranged from 0.30 cm^3 to 0.47 cm^3(averaged 0.42±0.05 cm^3).The compression time ranged from 3.00 min to 5.00 min(averaged 4.72±0.53 min).The incidence of diplopia was 3.23%,and the incidence of dry eyes/decreased corneal sensation was 12.90%.During the follow-up,one patient relapsed 10 months after surgery;the left patients recovered with disappeared complications.Conclusion The CT 3D reconstruction can reduce the difficulty of ovale foramen puncture during operation,assist the judgment and adjustment of intraoperative balloon volume,and improve the surgical efficacy.