三维数字减影血管造影透视引导下球囊压迫半月神经节治疗三叉神经痛的临床研究

Percutaneous balloon compression of trigeminal ganglion for trigeminal neuralgia under guidance of three-dimensional digital subtraction angiography

目的三维数字减影血管造影(3D-DSA)技术引导下定位卵圆孔行球囊压迫术, 穿刺针可在透视下一次性准确进入卵圆孔并对其疗效与安全性进行观察。方法收集北华大学附属医院神经外科2019年2月至2021年10月入院治疗的三叉神经痛患者38例, 于3D-DSA引导下对头颅进行图像重建, 选取最佳工作投影后透视确定卵圆孔的位置, 透视下穿刺针直接穿刺卵圆孔。测算最佳工作投影的角度范围和穿刺角度、穿刺深度、球囊形状。结果 3D-DSA可以使术者准确、安全、快速地一次成功穿刺卵圆孔。根据三维图像确定正确的卵圆孔位置。插入套管针的角度为患侧旋转14°~35°(平均22°)角, 颏顶位36°~54°(平均44°)角。侧位充盈球囊呈梨形, 压迫时间150~180 s。所有患者PBC术后疼痛均立即消失。1例患者术后1年复发, 再次PBC后疼痛消失, 随访2年未见复发。结论应用3D-DSA可为PBC提供可视化的卵圆孔穿刺, 避免误穿引起的并发症, 可以更精确地定位套管针的位置与球囊导管的深度, 疗效优良, 安全。

Objective To locate the foramen ovale with the guidance of three-dimensional digital subtraction angiography(3D-DSA)for treatment of trigeminal neuralgia by percutaneous balloon compression(PBC)trigeminal ganglion,and to investigate the effect and safety of this method,and the accuracy of puncture needle entrance the foramen ovale.Methods Thirty-eight patients with trigeminal neuralgia were treated by percutaneous balloon compression trigeminal ganglion under the guidance of 3D-DSA,from February 2019 to October 2021,at Department of Neurosurgery,Affiliated Hospital of Beihua University.After the position of foramen ovale was determined by fluoroscopy,the puncture needle was punctured into the foramen ovale directly.The best working projection angle range and puncture angle,puncture depth,balloon shape were calculated.Results Three-dimensional digital subtraction angiography could quickly and accurately locate the foramen ovale.According to the three-dimensional image,the correct position of the foramen ovale can be determined;the puncture needle can be inserted at an angle of 14°-35°(mean 22°)at oblique position of affected side and 36°-54°(mean 44°)at the mentopagital position;and the filling balloon image at lateral position under fluoroscopy was pear-shaped.The trigeminal ganglion was compressed for 150 to 180 seconds and the neuralgia was relieved promptly.One patient relapsed at 1 year after the operation and the pain remitted by percutaneous balloon compression trigeminal ganglion again.Conclusion The guidance of three-dimensional digital subtraction angiography can visualize the puncture needle and the depth of balloon catheter accurately for percutaneous balloon compression trigeminal neuralgia,with better effect and safety.