CT引导和非引导下半月神经节毁损术治疗三叉神经痛

PERCUTANEOUS PUNCTURE AND CHEMICAL NEUROLYSIS OF GASSERIAN GANGLION UNDER THE GUIDE OF COMPUTERIZED TOMOGRAPHY FOR THE TREATMENT OF TRIGEMINAL NEURALGIA

目的 :比较CT引导与非CT引导下经皮穿刺 ,用阿霉素毁损三叉神经半月节治疗三叉神经痛的疗效和并发症。方法 :89例原发性三叉神经痛患者 ,男 35例 ,女 5 4例 ,年龄 39～ 81岁 ,平均6 0 .4岁 ,病程 1～ 16年不等 ,分为两组。治疗前CT冠状及轴位扫描卵圆孔 ,除外继发性三叉神经痛。第一组 (4 4例 )不用CT引导穿刺半月神经节 ,第二组 (4 5例 )用CT引导穿刺的方向并确认针尖的位置 ,经造影确保穿刺针准确位于半月神经节内 ,两组均向半月神经节注射阿霉素。结果 :治疗后 12个月 ,两组分别有 2 6例和 36例完全无痛 ,分别有 17例和 6例未缓解。第一组的并发症数量及程度明显超过第二组。结论 :与传统的盲目穿刺方法相比 ,CT引导下经皮穿刺半月神经节毁损术对三叉神经痛的疗效更好 ,并发症更少。

Objective: The effects and the complications of percutaneous puncture and chemical neurolysis of trigeminal ganglion guided by or not by computerized tomography were compared for treating trigeminal neuralgia. Methods: Eighty-nine patients suffered from trigeminal neuralgia for 1～16 years,aged in 39～81 years, male 35 and 54 female, were randomly divided into two groups and checked by coral and axil CT scans before treatment to exclude the secondary neuralgia. The percutaneous puncture of oval foramen was not guided by CT in the group 1. The CT scan showed the direction of needle and the location of needle tip during the percutaneous puncture of oval foramen in group 2. 10 mg of adriamycin was injected into trigeminal ganglia as a neurolytic agent after the puncture in both group. Results: By the results of 12 months follow up the neuralgia disappeared in 26 cases in group 1 and in 36 cases cases in group 2. There were no threapeutic effects in 17 patients in group 1 and in 6 patients in group 2. The side effects or complications in group 1 were more than those in group 2. Conclusion: Percutaneous puncture and chemical neurolysis of trigeminal ganglion under the guide of computerized tomography is a method with better effects and less complications for the treatment of trigeminal neuralgia.