下颌骨内侧角穿刺经卵圆孔内侧壁进针射频热凝治疗眼支三叉神经痛

Percutaneous radiofrequency thermocoagulation for the trigeminal neuralgia of ophthalmic branch through puncturing medial wall of the foramen ovale from mandibular medial angle

目的探讨下颌骨内侧角穿刺经卵圆孔内侧壁进针射频热凝治疗三叉神经眼支痛的临床应用。方法收集2015年1月到2019年8月收治的原发性三叉神经眼支痛患者38例作为研究对象,均采用下颌骨内侧角穿刺经卵圆孔内侧壁进针近斜坡部位射频控温热凝治疗,出院后进行3个月的随访,观察术中三叉神经眼支疼痛复制率,比较术前、术后1 d,1、3个月视觉模拟评分(VAS)变化及治愈率。结果术中眼支疼痛复制率84.2%。术前VAS评分7.7±0.1,术后1 d,1、3个月VAS评分为1.2±0.4,0.1±0.1,0.1±0.1。术后1 d,1、3个月与术前相比,VAS评分明显下降,(P<0.001),差异有显著统计学意义。术后第1 d、1及3个月治愈率分别为73.7%、97.4%、97.4%。结论下颌骨内侧角穿刺经卵圆孔内侧壁进针,能准确复制眼支三叉神经疼痛症状,是射频热凝治疗三叉神经痛眼支有效方法。

Objective To discuss the clinical application of percutaneous radiofrequency thermo-coagulation(PRT)through puncturing medial wall of the foramen ovale from mandibular medial angle in treating trigeminal neuralgia(TN)of ophthalmic branch.Methods A total of 38 patients with primary TN of ophthalmic branch,who were admitted to the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine of China during the period from January 2015 to August 2019,were enrolled in this study.By puncturing medial wall of the foramen ovale from mandibular medial angle the radiofrequency thermocoagulation needle was inserted to the site of the clivus,which was followed by radiofrequency thermocoagulation(RT).After discharge all the patients were followed up for 3 months.The intraoperative pain replication rate of ophthalmic branch of trigeminal nerve was calculated.The postoperative 1-day,1-month and 3-month visual analog scale(VAS)scores were compared with the preoperative ones,and the postoperative1-day,1-month and 3-month cure rates were calculated.Results The intraoperative pain replication rate of ophthalmic branch of trigeminal nerve was 84.2%.The preoperative mean VAS score was(7.7±0.1)points,and the postoperative 1-day,1-month and 3-month mean VAS scores were(1.2±0.4)points,(0.1±0.1)points and(0.1±0.1)points respectively.The postoperative 1-day,1-month and 3-month VAS scores were significantly lower than the preoperative VAS score,the differences were statistically significant(P<0.001).The postoperative1-day,1-month and 3-month cure rates were 73.7%,97.4%and 97.4%respectively.Conclusion In treating TN of ophthalmic branch with PRT therapy,the use of puncturing medial wall of the foramen ovale from mandibular medial angle can accurately replicate the trigeminal nerve ophthalmic branch pain symptoms,and this technique is an effective method to treat the TN of ophthalmic branch.