CT引导下半月节射频热凝治疗顽固性三叉神经痛  

CT-guided Radiofrequency Thermocoagulation of the Semilunar Ganglion for Intractable Trigeminal Neuralgia

作　　者：周煦燕[1] 黄冰[1] 姚明[1] 侯健[1] 祝则峰[1] 包梅芳 杜建龙 陆雅萍[1] 孙建良[1] 

机构地区：[1]浙江省嘉兴市第一医院麻醉科,嘉兴314000 [2]浙江省桐乡市第一人民医院麻醉科,桐乡314100

出　　处：《中国微创外科杂志》2011年第10期953-955,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：浙江省嘉兴市科技局2011年第一批科技计划项目(2011AY1050-1)

摘　　要：目的探讨CT引导下半月节射频热凝治疗顽固性三叉神经痛的疗效。方法 2007年3月～2010年12月,在CT引导下对68例常规口服药物治疗无效的三叉神经痛进行经皮穿刺半月节射频热凝治疗,三叉神经第Ⅰ支9例,第Ⅱ支12例,第Ⅲ支17例,第Ⅰ+Ⅱ支3例,第Ⅱ+Ⅲ支24例,第Ⅰ+Ⅱ+Ⅲ支3例。结果 68例均于CT引导下穿刺进入相应卵圆孔。66例治疗后疼痛消失,1例减轻,1例无效。68例随访3～48个月,平均31个月,5例复发,复发率7.4%。1例三叉神经第Ⅰ支射频术后同侧眼球结膜充血,2周后角膜溃疡,8周后溃疡穿孔,10周后穿孔自行愈合,但该眼视力丧失。结论 CT引导下半月节射频热凝能有效治疗顽固性三叉神经痛。对于三叉神经第Ⅰ支的射频治疗,一定要控制热凝温度于70℃以下,严密监测射频过程中患者的角膜反射,做到角膜反射迟钝即结束治疗。Objective To investigate the curative effect of CT-guided radiofrequency thermocoagulation of the semilunar ganglion for intractable trigeminal neuralgia. Methods From March 2007 to December 2010,68 cases of intractable trigeminal neuralgia,who had poor response to conventional medicine,received percutaneous oval hole puncture and radiofrequency thermocoagulation of the semilunar ganglion.The puncture was guided by CT.And the trigeminal neuralgia was located at the Ⅰ,Ⅱ,and Ⅲ branch in 9,12,and 17 patients,and Ⅰ＋Ⅱ,Ⅱ＋Ⅲ,Ⅰ＋Ⅱ＋Ⅲ branches in 3,24,and 3 patients,respectively.Results All the 68 patients recieved puncture into the corresponding oval hole under the guidance by CT.The neuralgia was cured by radiofrequency thermocoagulation of the semilunar ganglion in 66 patients,1 case was improved,another one showed no response to the treatment.Follow-up was achieved in the 68 patinets for 3 to 48 months（mean,31 months）,during which 5 patients showed recurrence（recurrence rate 7.4%）.In one patient,after radiofrequency thermocoagulation for the Ⅰ branch of the trigeminal,the ipsilateral conjunctiva bulbi developed hyperemia,and became corneal ulcer in 2 weeks.The ulcer was perforated at week 8,and then was healed at week 10,but without the vision resumed. Conclusions CT-guided radiofrequency thermocoagulation of the semilunar ganglion is effective for intractable trigeminal neuralgia;For the first（Ⅰ） branch of the trigeminal,the temperature of radiofrequency thermocoagulation must be controlled under 70 ℃,and the corneal reflex must be monitored carefully during the treatment,which shall be stopped as soon as the corneal reflex becames blunt.

关 键 词：三叉神经痛 射频热凝 CT引导 

分 类 号：R745.11[医药卫生—神经病学与精神病学]