三叉神经痛半月节射频热凝术中神经分支定位的电生理监测  

Neurophysiological monitoring of nerve branch location in semilunar ganglion radiofrequency thermocoagulation for trigeminal neuralgia

作　　者：李秀华[1] 武百山[1] 左欣鹭 杨惠婕[1] 李艳[1] 何亮亮[1] 倪家骧[1] 

机构地区：[1]首都医科大学宣武医院疼痛诊疗中心,北京100053 [2]承德护理职业学院外科研究所

出　　处：《中华神经外科杂志》2015年第12期1241-1244,共4页Chinese Journal of Neurosurgery

基　　金：基金项目：首都临床特色应用研究（Z131107002213154）

摘　　要：目的 观察半月节射频热凝术治疗三叉神经痛术中,逆向神经传导电生理监测对三叉神经第2支（V2）、第3支（V3）定位的可行性及敏感性.方法 回顾性研究2013年11月至2014年5月,在首都医科大学宣武医院疼痛诊疗中心采用三叉神经半月节射频热凝术治疗的典型三叉神经痛患者的临床资料,共99例（139个分支,排除第1支疼痛者）.CT定位引导下穿刺针进入卵圆孔后,给予感觉（50 Hz,0.1 ms）和运动（2 Hz,1 ms）刺激,根据患者主诉明确刺激是否覆盖三叉神经分支疼痛区域,定位准确且刺激电压≤0.5V时说明穿刺针的位置正确.应用多通道肌电图仪从0V开始监测各分支的神经传导波形,并记录相应分支出现波形的阈电压值.结果 术后第2天疼痛完全缓解（视觉模拟评分≤3分）率为96.0％ （95/99）.V2和V3分支定位时,肌电图仪分别记录到V2或V3支痛患者在相应通道出现明显的神经传导波形.50 Hz感觉刺激时,V3支阈电压值为（0.07±0.04）V,V2支为（0.10±0.06）V,两者比较差异有统计学意义（P =0.002）;2 Hz运动刺激时,V3支阈电压值为（0.09±0.04）V,V2支为（0.13±0.07）V,两者比较差异有统计学意义（P =0.013）.结论 逆向神经传导监测可用于三叉神经半月节射频热凝术中V2、V3分支的定位,且V3支更敏感.Objective To observe the feasibility and sensitivity of electrophysiological monitoring of antidromic nerve conduction in the location of trigeminal nerve 2 （V2） or 3 （V3） in semilunar ganglion radiofrequency thermocoagulation for the treatment of trigeminal neuralgia.Methods From November 2013 to May 2014,a total of 99 patients with typical trigeminal neuralgia （139 branches,the patients with the first branch pain were excluded） treated with the semilunar ganglion radiofrequency thermocoagulation of trigeminal nerve at the Pain Diagnosis and Treatment Center,Beijing Xuanwu Hospital,Capital Medical University were enrolled retrospectively.After the puncture needle entered the foramen ovale under the guidance of CT location,sensory （50 Hz,0.1 ms） and motor （2 Hz,1 ms） stimulations were given.According to the complaints of patients,whether the stimulation covered the painful area of trigeminal nerve branches was made clear.The location was accurate and when the stimulation voltage was ≤ 0.5 V,the position of the puncture needle was correct.Multi-channel electromyograph was used to detect the nerve conduction waveforms of each branch from 0V and the threshold voltage value of the waveforms of the corresponding branches was documented.Results The complete remission rate of pain （Visual analog scale ≤3） the next day after operation was 96% （95/99）.When the V2 and V3 branches were located,electromyograph recorded obvious nerve conduction waveforms in the corresponding channels in patients with V2 or V3 branch pain.When the sensory stimulation was 50 Hz,the threshold voltage value of V3 branch was 0.07 ±0.04 V,and V2 branch was 0.10 ± 0.06 V.There was significant difference between both of them （P =0.002）.When the motor stimulation was 2 Hz,the threshold voltage value of V3 branch was 0.09±0.04 V,and V2 branch was 0.13 ±0.07 V.There was significant difference between both of them （P =0.013）.Conclusions Nerve antidromic conduction monitoring can be used in the location of V2 an

关 键 词：三叉神经痛 半月节 射频热凝术 逆向神经传导监测 

分 类 号：R745.11[医药卫生—神经病学与精神病学]