岩尖三叉神经半月节压迹内定位在原发性三叉神经痛射频热凝治疗中的应用及疗效分析  

Positioning technology in trigeminal notch in treatment of primary trigeminal neuralgia

作　　者：崔永华[1] 张立勇[1] 虞正权[2] 陈恒林[1] 夏咏本[1] 韩清[1] 何云峰[1] 王张明[1] 朱晓文[1] 

机构地区：[1]南通大学附属建湖医院神经外科,盐城224700 [2]苏州大学附属第一人民医院神经外科,苏州215006

出　　处：《中华神经医学杂志》2015年第9期958-961,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨以岩尖三叉神经半月节压迹为定位标记在原发性三叉神经痛射频热凝治疗中的应用及疗效。方法回顾性分析南通大学附属建湖医院神经外科自2009年8月至2012年9月收治的43例原发性三叉神经痛患者资料，根据定位标记不同分为卵圆孔组（21例）及半月节压迹组（22例）。2组患者均经Hartel前入路，卵圆孔组经卵圆孔穿刺，调整穿刺深度，方波验证后热凝毁损；半月节压迹组以岩尖三叉神经半月节压迹为定位标记进行内定位。横向定位：下颌神经痛以压迹外1／3为靶点，上颌神经痛以压迹中1／3为靶点，眼神经痛以压迹内1／3为靶点；前后定位：以压迹骨面前方5mm以内为靶点。以穿刺时间衡量穿刺难度，比较2组穿刺难度、穿刺成功率和相关并发症发生率，记录术后1d、1个月、6个月、12个月、24个月时视觉模拟（VAS）评分并评估镇痛效果。结果2组患者穿刺成功率均为100％。卵圆孔组穿刺时间为（5．0±0．4）min．半月节压迹组穿刺时间为（12．0±0．7）min，差异有统计学意义（P〈O．05）。卵圆孔组穿刺并发症（皮下血肿1发生率低于半月节压迹组4．8％、13．6％，差异有统计学意义（P〈O．05）。卵圆孔组射频并发症高于半月节压迹组，其中2组患者射频热凝累及正常三叉神经分支比例分别为42．9％％、13．6％，差异有统计学意义（P〈0．05），累及运动纤维比例分别为14．3％、4．5％，差异有统计学意义（P〈0．051；2组患者术后12、24个月时疗效差异有统计学意义（P〈0．05）。结论岩尖三叉神经半月节压迹内定位射频热凝治疗三叉神经痛具有射频并发症少、远期疗效好等优势，但对穿刺技术要求相对较高。Objective To study the ovale or trigeminal notch positioning and puncture techniques using thin slice CT scan in treatment of trigeminal neuralgia through radiofrequency thermocoagulation, and analyze its efficacy. Methods The clinical data of 43 patients with primary trigeminal neuralgia, admitted to our hospital from August 2009 to September 2012, were retrospectively analyzed. According to the positioning marks, two groups were divided. Both group A （n=21） and group B （n=22） adopted Hartel anterior approach; puncture in group A was through foramen ovale, adjusting the direction and depth of the puncture needle, observing the patient＇s response to electrical stimulation, and damaging the sensory fiber; puncture in B group was through trigeminal gasserian ganglion notch, damaging neurons through radiofrequency thermocoagulation. Transverse and longitudinal positioning was performed in the two groups, and mandibular neuralgia, maxillary neuralgia and ophthalmic neuralgia were located in the trigeminal notch ~om outside to inside, and the longitudinal location targeted in the trigeminal notch bone surface in front of 5 mm. The puncturing time, puncturing success rate and complications rate between the two groups were recorded. The visual analog scale （VAS） was scored, respectively, one d, and one, 6, 12 and 24 months after the surgery. The outcome responses of pain relief were evaluated. Results The puncture success rate in both two groups was 100%; the puncturing time in group A （[5.0±0.4] min） was significantly shorter than that in group B （[12.0±0.7] min, P〈0.05）; the puncturing complication rate in group A （4.8%） was significantly lower than that in group B （13.6%, P〈0.05）, but the complication rate of radiofrequency in group A was significantly higher than that in group B （involving normal nervi trigeminus branches： 42.9% vs. 13.6%, involving motor fibers： 14.3% vs. 4.5%, P〈0.05）. The treatment effect of group B was better than that group A 12 and 24 months after

关 键 词：卵圆孔 半月节压迹 三叉神经痛 热凝射频 

分 类 号：R745.11[医药卫生—神经病学与精神病学]