神经导航联合电生理监测辅助下半月神经节射频热凝术治疗原发性三叉神经痛  

Percutaneous radiofrequency thermocoagulation of gasserian ganglion under guidance of neuronavigation combined with electrophysiological monitoring for patients with primary trigeminal neuralgia

作　　者：荣道建[1] 张海波[1] 潘海[1] 姜雪 宋君[2] RONG Dao-Jian;ZHANG Hai-Bo;PAN Hai;JIANG Xue;SONG Jun(Pain Diagnosis and Treatment Center,Central Hospital Affiliated to Shenyang Medical College,Shenyang 110024,China)

机构地区：[1]沈阳医学院附属中心医院疼痛诊疗中心,沈阳110024 [2]沈阳医学院附属中心医院放射线科,沈阳110024

出　　处：《中国临床神经外科杂志》2021年第1期11-13,共3页Chinese Journal of Clinical Neurosurgery

基　　金：辽宁省自然科学基金(201602726)。

摘　　要：目的探讨神经导航联合电生理监测辅助下半月神经节射频热凝术(PRT)治疗三叉神经痛的疗效。方法回顾性分析2016年3月至2018年6月在神经导航联合电生理监测辅助下采用PRT治疗的38例原发性三叉神经痛的临床资料。术前及术后1年采用视觉模拟量表(VAS)评分评价疼痛程度。术后1年,采用巴罗神经病学研究所疼痛预后分级(BNI)评分评估疼痛预后,Ⅰ~Ⅲ级为有效,Ⅳ~Ⅴ级为无效。结果38例卵圆孔首次穿刺成功35例,成功率为92.1%。术后1年VAS评分[(1.5±1.2)分]较术前[(8.5±1.0)分]明显降低(P<0.05)。术后1年,BNI评分Ⅰ级29例,Ⅱ级4例,Ⅲa级2例,Ⅲb级l例,Ⅳ级1例,Ⅴ级1例;有效率为94.7%(36/38)。术中23例(60.5%)出现血压明显上升,5例(13.2%)发生心动过缓。术后出现面部麻木34例(89.5%)、穿刺部位皮下血肿4例(10.5%)、口唇带状疱疹2例(5.3%)、咬肌无力1例(2.6%),经对症治疗3个月后均逐渐恢复。术后随访1年,没有发生颅内出血、脑脊液漏及颅内感染等严重并发症。结论神经导航联合电生理监测技术可精确定位半月神经节靶点,提高手术的安全性及临床疗效。Objective To explore the clinical effect of percutaneous radiofrequency thermocoagulation of gasserian ganglion under guidance of neuronavigation combined with electrophysiological monitoring(PRT-NCM)on the patients with primary trigeminal neuralgia(PTN).Methods The clinical data of 38 patients with PTN who underwent PRT-NCM from March 2016 to June 2018 were analyzed retrospectively.Visual analogue scale(VAS)score was used to evaluate the pain before and 1 year after the operation.One year after the operation,the pain prognosis grade score of Barrow Institute of Neurology(BIN)was used to evaluate the pain prognosis,with effectiveness of gradeⅠ~Ⅲ and no effectiveness of grade Ⅳ~Ⅴ.Results The success rate of first puncture was 92.1%(35/38).The VAS score[(1.5±1.2)points]1 year after the operation was significantly lower than that[(8.5±1.0)points]before the operation(P<0.05).One year after the surgery,BNI grade Ⅰ was achieved in 29 patients,grade Ⅱ in 4,grade Ⅲ a in 2,grade Ⅲb in l,grade Ⅳ in 1,and grade Ⅴ in 1;the effective rate was 94.7%(36/38).There were no serious complications such as intracranial hemorrhage,cerebrospinal fluid leakage and intracranial infection during the 1-year follow-up.Conclusions PRT is an effective treatment method for the patients with PTN.NCM can help to visualize the whole operation process,accurately locate the target of the gasserian ganglion,improve the safety and efficacy of the operation and reduce the complications of the operation.

关 键 词：原发性三叉神经痛 半月神经节射频热凝术 神经导航 电生理监测 疗效 

分 类 号：R745.11[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]