DSA引导下选择性神经干射频热凝治疗三个分支均受累的原发性三叉神经痛的安全性及疗效

Safety and efficacy of DSA-guided selective percutaneous radiofrequency thermocoagulation in the treatment of patients with primary trigeminal neuralgia involving three branches

目的探讨数字减影血管造影机(DSA)引导下选择性神经干射频热凝治疗3个分支均受累的原发性三叉神经痛(PTN)的安全性与疗效。方法收集2015年1月至2019年1月期间,淮安市淮安医院疼痛与介入科、淮安市第二人民医院疼痛科,涟水县人民医院神经内一科及淮安市淮阴医院介入科收治的52例3个分支均受累的PTN患者,性别、年龄不限。所有患者均接受选择性神经干射频热凝治疗。选择卵圆孔内的下颌神经干、圆孔内的上颌神经干、眶上缘的眶上神经干与滑车上神经干为穿刺靶点;分别给予下颌神经干75℃的射频热凝处理;上颌神经干、眶上神经干与滑车上神经干90℃的射频热凝处理。记录患者治疗前及治疗后1周、6个月、12个月的视觉模拟评分(VAS),疗效及并发症情况。结果最终完成研究者44例。治疗前触电样疼痛VAS评分(8.7±0.7)分,治疗后各时点触电样疼痛VAS评分均为0,差异均有统计学意义(P均<0.05)。与术前比较,治疗后各时点并发症持续性麻痛、面部肿胀、面部感觉缺失及咀嚼功能下降发生率较高,差异均有统计学意义(P均<0.05)。治疗后1周优效者36例(81.8%),良效者8例(18.2%),治疗中是否采用DSA三维影像进行验证穿刺位置对疗效影响差异无统计学意义(P>0.05)。随访12个月内均未见复发。结论DSA引导下经皮选择性神经干射频热凝治疗3个分支均受累的PTN安全、有效。

Objective To investigate the safety and efficacy of digital subtraction angiography(DSA)guided selective percutaneous radiofrequency thermocoagulation for the treatment of patients with primary trigeminal neuralgia involving three branches.Methods Fifty-two patients with primary trigeminal neuralgia involving all branches of the nerve accepted radiofrequency thermocoagulation,were retrospective analyzed,regardless of age and sex,from January 2015 to January 2019 in Department of Pain and Intervention Management,Huaian Hospital of Huaian City;Department of Pain Management,Second People's Hospital of Huaian City;Department of Neurology,Lianshui County People's Hospital;Department of Intervention Management,Huaiyin Hospital of Huaian City.The mandibular neural trunk in the foramen ovale,the maxillary neural trunk in the foramen rotundum,the supraorbital neural trunk and supratrochlear neural trunk nearby supraorbital margin were selected as the puncture targets,and treated by radiofrequency thermocoagulation.Visual analogue scale(VAS)of electroshock-like pain was recorded before the treatment,and 1 week,6 months,12 months after the treatment,and incidences of complications were recorded at each time point after the treatment.Results Forty-four cases were completed the follow-up finally.VAS of electroshock-like pain was(8.7±0.7)before the treatment,and 0 at 1 week,6 months and 12 months after the treatment(all P<0.05).The incidences of persistent numbness,facial swelling,facial hypoesthesia and decreased chewing function were higher at each time point after the treatment(all P<0.05).There were 36 cases(81.8%)with excellent effects,8 cases(18.2%)with good effects at 1 week after the treatment.There was no significant difference in DSA-3D images used or not for verification after successful fluoroscopic localization puncture in 25 patients(P>0.05).No recurrence was observed during 12 months of follow-up.Conclusion DSA-guided selective percutaneous radiofrequency thermocoagulation is safe and effective for the treatment of patients with primary trigeminal neuralgia involving three branches of the trigeminal nerve.