经翼腭窝途径超声引导三叉神经阻滞治疗三叉神经痛

An approach of trigeminal nerve block via pterygopalatine fossa under ultrasound-guidance in the treatment of trigeminal neuralgia

目的 探讨超声引导下经翼腭窝途径三叉神经阻滞治疗三叉神经痛的疗效.方法 选择三叉神经痛和带状疱疹后三叉神经痛患者7例,在超声引导下经下颌骨乙状切迹入翼腭窝阻滞三叉神经,阻滞后15 min观察三叉神经各分支阻滞情况,于治疗前、术后24 h、1个月、3个月时采用VAS评分评估患者疼痛程度,并记录并发症.结果 V1、V2、V3均被阻滞为29％(2/7例),V2、V3同时被阻滞为57％(4/7例),V2全部被阻滞为100％(7/7例).7例患者在术后24 h、1个月、3个月时疼痛缓解有效率均为100％;5例患者VAS评分较治疗前有明显下降,2例合并带状疱疹后神经痛的患者下降不明显.仅有1例患者出现短时间(2 h)面部肿胀,未见其他并发症.结论 超声引导下经翼腭窝途径三叉神经阻滞治疗三叉神经痛是一种安全有效的方法.

Objective To explore the approach of trigeminal nerve block via pterygopalatine fossa under ultrasound-guidance in the treatment of trigeminal neuralgia.Methods Five patients with primary trigeminal neuralgia and two patients with trigeminal neuralgia after herpes zoster received trigeminal nerve block under ultrasound-guidance via sigmoid incisure of mandible into pterygopalatine fossa.Superficial sensory in the cutaneous distribution area of the branches of trigeminal nerve pain was observed respectively after 15 minutes.The efficacy was assessed by visual analogue scale (V AS) before and at 24 h,1 month and 3 months after the treatment,and the occurrence of complications was observed as well.Results The branches V1,V2,V3 of trigeminal nerve were all blocked in 2 patients (29％),V2 and V3 in 4 patients (57％) and V2 in 7 patients (100％).The effective rate was 100％ at 24 h,1 month,3 months after the treatment.VAS in 5 patients with primary trigeminal neuralgia was significantly lower at 3 months after the treatment than that before the treatment,without obvious decrease in two patients with trigeminal neuralgia after herpes zoster.One patient showed facial swelling for two hours,without other complication.Conclusion Trigeminal nerve block via pterygopalatine fossa under ultrasound-guidance is a safe and effective approach in the treatment of trigeminal neuralgia.