卵圆孔形态和外口面积对半月神经节球囊压迫术的影响  

Effect of foramen ovale shape and the size of external orifice on the balloon compression of semilunar ganglion in trigeminal neuralgia

作　　者：徐武[1] 姜成荣 梁维邦[1] Xu Wu;Jiang Chengrong;Liang Weibang(Department of Neurosurgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院麻神经外科,南京210008

出　　处：《中华脑科疾病与康复杂志（电子版）》2021年第4期196-199,共4页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

基　　金：江苏省第十五批“六大人才高峰”高层次人才选拔培养资助项目(WSN-135)。

摘　　要：目的探讨卵圆孔的形态、外口的大小对半月神经节球囊压迫术(PMC)操作的影响。方法纳入南京大学医学院附属鼓楼医院神经外科自2017年1月至2018年6月收治的382例原发性三叉神经痛(TN)患者,术前均行颅底CT薄层扫描,3D重建后,从穿刺方向观察卵圆孔形态,并测量卵圆孔外口面积,结合术中穿刺结果评价卵圆孔形态、外口大小对手术的影响。结果卵圆孔穿刺后,球囊置入Meckel’s腔内并呈现典型“梨形”显影即为成功,纳入成功组;卵圆孔穿刺失败或卵圆孔穿刺成功,但球囊未能成功置入Meckel’s腔、未能典型“梨形”显影即为失败,纳入失败组。成功组356例(93.19%),卵圆孔呈椭圆形324例(91.01%),外口面积范围23.42-34.23 mm^(2),中位面积为30.27 mm^(2);卵圆孔呈圆形32例(8.99%),外口面积范围24.15-33.00 mm^(2),中位面积为30.15 mm^(2)。失败组26例(6.81%),其中卵圆孔穿刺失败1例,Meckel’s腔穿刺失败25例;卵圆孔外口呈椭圆形20例(76.92%),外口面积范围11.67-48.84 mm^(2),中位面积为24.15 mm^(2);卵圆孔外口呈圆形6例(23.08%),外口面积范围14.38-43.51 mm^(2),中位面积为25.40 mm^(2),失败组中虽有1例外口面积为48.84 mm^(2),大于所有成功组病例,但失败组中位面积数显著小于成功组(P<0.05);失败组中卵圆孔外口呈现圆形的比例大于成功组(P<0.05)。1例卵圆孔穿刺失败患者的卵圆孔呈椭圆形,外口面积20.00 mm^(2),但卵圆孔内、外口成角,穿刺针不能通过。结论半月神经节PMC的成功率较高,与卵圆孔相关的穿刺失败多与卵圆孔外口圆形、外口过小有关,少数与卵圆孔外口过大有关,特殊情况下,卵圆孔内、外口的折曲、成角也会导致手术失败。Objective To explore the effect of the shape of foramen ovale and the size of the external orifice on percutaneous microballoon compression(PMC)of the semilunar ganglion.Methods Three hundred and eighty-two patients with primary trigeminal neuralgia(TN)who admitted to the Neurosurgery Department of Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,from January 2017 to June 2018 were underwent thin-layer CT scanning of skull base before operations,then the images were reconstructed in three dimensions,the shape of foramen ovale was observed and the area of foramen ovale was measured from the direction of surgical puncture subsequently.Finally evaluate the effect of the shape of foramen ovale and the size of external orifice on the operations according to the results of intraoperative puncture.Results According to the balloon was placed into Meckel’s cavity and showed a typical“pear shaped”imaging,which was regarded as successful and included in the successful group.The failure of foramen ovale puncture or the success of foramen ovale puncture,but the balloon failed to be placed into Meckel’s cavity and failed to show a typical“pear shaped”,which was regarded as failure and included in the failure group.There were 356 patients in the successful group,the success rate was 93.19%,the oval foramens look like oval in 324 cases(91.01%),and the areas of external orifice were 23.42-34.23 mm^(2),the median area was 30.27 mm^(2),oval foramens with round shape in 32 cases(8.99%),the areas of the external orifice were 24.15-33.00 mm^(2),median area was 30.15 mm^(2).There were 26 patients in the successful group,the failure rate was 6.81%.Among them,1 failed case due to unsuccessful puncture of foramen ovale,the remaining 25 cases failed to Meckel’s capsule.Twenty cases(76.92%)with oval outer opening,and the areas were 11.67-48.84 mm^(2),the median area was 24.15 mm^(2) in this group,otherwise 6 cases(23.08%)with round outer opening,their areas were 14.38-43.51 mm^(2),the me

关 键 词：三叉神经痛 半月神经节 球囊压迫术 卵圆孔 CT?鄄3D重建 

分 类 号：R651.3[医药卫生—外科学]