经皮穿刺微球囊压迫术治疗三叉神经痛术前卵圆孔CT重建参数与球囊压力的相关性分析  

Correlation of preoperative reconstruction of foramen ovale parameters and intraluminal balloon pressure during percutaneous balloon compression for trigeminal neuralgia

作　　者：王巧 郭刚文[1] 黄东[1] 李振兴 周浩宬 Wang Qiao;Guo Gangwen;Huang Dong;Li Zhenxing;Zhou Haocheng(Department of Pain Medicine,the Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院疼痛科,长沙410013

出　　处：《中华医学杂志》2021年第43期3549-3553,共5页National Medical Journal of China

基　　金：国家自然科学基金(81771101,81901146)。

摘　　要：目的研究经皮穿刺微球囊压迫术(PBC)球囊压力与卵圆孔解剖参数的关系,探讨术前卵圆孔CT重建参数对PBC术中球囊压力的预测价值。方法选取2020年11月至2021年4月中南大学湘雅三医院疼痛科接受全身麻醉下行PBC术治疗原发性三叉神经痛患者20例。术前行颅底高分辨三维CT重建,并于轴位图像上测量卵圆孔最大横截面的长径、短径及卵圆孔面积。术中运用便携式电子测压计持续监测记录PBC术中球囊充盈过程中的压力变化。相关性分析检验PBC术中球囊压力与卵圆孔解剖参数之间的相关性。结果18例患者PBC术后疼痛完全缓解,1例明显缓解,1例部分缓解。卵圆孔最大横截面长径为(7.8±1.7)mm。PBC术中微球囊充盈时压力峰值(P_(M))为(194±27)kPa,开始压迫时微球囊压力值(P_(0))为(164±28)kPa,压迫120 s后微球囊压力(P_(120))为(135±20)kPa。相关性分析显示:P_(0)与卵圆孔长径呈正相关(r=0.56,P<0.05),与卵圆孔短径(r=0.24,P>0.05)、卵圆孔面积(r=0.36,P>0.05)以及球囊充盈程度(r=-0.09,P>0.05)均无相关性;P_(120)与卵圆孔长径呈正相关(r=0.54,P<0.05),与卵圆孔短径(r=0.18,P>0.05)、卵圆孔面积(r=0.28,P>0.05)以及球囊充盈程度(r=-0.13,P>0.05)均无相关性。结论三叉神经痛患者PBC术中球囊压力与卵圆孔长径存在相关性,通过术前颅底高分辨CT对卵圆孔进行重建,可以为预测PBC术中球囊压力目标值提供依据。Objective To explore the relationship between the anatomic parameters of foramen ovale and intraluminal pressure during percutaneous balloon compression(PBC)in the treatment of primary trigeminal neuralgia.Methods Twenty patients diagnosed with primary trigeminal neuralgia in the Department of Pain Medicine of the Third Xiangya Hospital,Central South University between November 2020 and April 2021 were enrolled.Three-dimensional(3D)high-resolution CT reconstruction of skull base was performed preoperatively to evaluate the parameters of foramen ovale.The intraluminal balloon pressure was continuously recorded during the PBC procedure.Correlation analysis was conducted between intraluminal pressure and foramen ovale parameters.Results Eighteen patients had complete pain relief,1 had obvious relief,and 1 had partial relief after PBC.The maximum cross-sectional length of the foramen ovale was(7.8±1.7)mm.The peak intraluminal pressure(P_(M))during PBC was(194±27)kPa.The intraluminal pressure was(164±28)kPa at initial compression(P_(0)),and(135±20)kPa after compression for 120 seconds respectively.Correlation analysis showed that the P_(0) was positively and significantly correlated with the length of foramen ovale(r=0.56,P<0.05),but not with the width of foramen ovale(r=0.24,P>0.05),the area of foramen ovale(r=0.36,P>0.05)and the degree of balloon filling(r=-0.09,P>0.05).Similarly,P_(120) was significantly correlated with the length of foramen ovale(r=0.54,P<0.05).No significant correlation was observed between P_(120) and the width of the foramen ovale(r=0.18,P>0.05),the area of the foramen ovale(r=0.28,P>0.05)or the width of balloon filling(r=-0.13,P>0.05).Conclusions The length of foramen ovale correlates with the intraluminal pressure during PBC procedure in trigeminal neuralgia patients.Parameters of foramen ovale obtained via preoperative high-resolution CT reconstruction of skull base may provide reference for predicting targeted intraluminal balloon pressure during PBC.

关 键 词：三叉神经痛 经皮穿刺微球囊压迫术 球囊压力 卵圆孔 

分 类 号：R651.3[医药卫生—外科学]