C臂CT在经皮三叉神经痛球囊压迫术中的应用价值  

Application of C-arm CT in percutaneous balloon compression for trigeminal neuralgia

作　　者：尹姬[1] 刘诤[1] 师昕翌 马菁[1] 朱力[1] YIN Ji;LIU Zheng;SHI Xinyi;MA Jing;ZHU Li(Catheter Room,Department of Radiology,General Hospital of Ningxia Medical University,Yinchuan,Ningxia Hui Autonomous Region 750004,China)

机构地区：[1]宁夏医科大学总医院放射导管室,宁夏银川750004

出　　处：《介入放射学杂志》2023年第8期755-759,共5页Journal of Interventional Radiology

基　　金：宁夏回族自治区重点研发计划项目(2022BEG03157);宁夏教育厅科研项目(NGY2020036)。

摘　　要：目的探讨C臂CT引导下经皮三叉神经半月节球囊压迫术治疗三叉神经痛的应用价值。方法回顾性分析采用C臂CT(Xper-CT)引导下经皮三叉神经半月节球襄压迫术治疗三叉神经痛患者40例,所有患者均进行C臂CT程序扫描,并通过X-travision工作站进行颅骨后处理重建,引导穿刺针进入卵圆孔及球囊到位,确定球囊头端位于Meckel’s腔,充盈球囊。术后记录手术剂量面积乘积(dose area product,DAP)、空气比释动能(cumulative air kerma,CAK)、曝光时间(fluo time,FT),分析辐射剂量。结果40例患者均通过C臂CT后处理重建技术引导卵圆孔穿刺成功(其中小卵圆孔2例);40例患者中通过C臂CT后处理重建技术确定球囊一次性到位并获得满意梨形21例(52%),通过C臂CT后处理重建技术分析后多次调整球囊位置及方向,使球囊头端位于岩骨切迹,并获得满意梨形12例(30%),7例(18%)患者未获得满意梨形。术后40例患者疼痛完全消失17例(42%),疼痛满意缓解21例(53%);疼痛缓解不满意2例(5%);总有效率95%。术后伴面部麻木26例(65%),咀嚼肌无力9例(23%)。40例患者DAP、CAK、FT分别为(79.39±23.15)Gycm^(2)、(245.07±84.04)mGy、(5.20±1.30)min。结论C臂CT引导下经皮三叉神经半月节球囊压迫术直观准确显示穿刺针、卵圆孔、球囊、岩骨脊的三维结构及其相互位置关系,尤其对解剖变异或异常增生的显示更具优势。Objective To discuss the application of C-arm CT-guided percutaneous balloon compression(PBC)in treating trigeminal neuralgia.Methods The clinical data of 40 patients with trigeminal neuralgia,who received C-arm CT(Xper-CT scanner)-guided PBC,were retrospectively analyzed.C-arm CT programmed scan was performed in all patients,and post processing reconstruction of the skull was carried out by using an X-travision workstation.Under the guidance of the reconstructed images,the puncture needle was inserted into the foramen ovale and the balloon was placed to the exact site.After determining that the balloon tip was located in the Meckel's cavity,the balloon was filled up.After PBC,the dose area product(DAP),the cumulative air kerma(CAK),and the fluoroscopic time(FT)were recorded,which were used for analyzing radiation dose.Results In all the 40 patients(including 2 patients having tiny foramen ovale),foramen ovale was successfully punctured under the guidance of the reconstructed images.Among the 40 patients,in 21 patients(52%)the balloon was inserted into accurate site with single procedure and it presented as a satisfactory pear shape,in 12 patients(30%)the balloon was placed at the petrous notch after several times of adjusting the balloon position and it presented as a satisfactory pear shape,and in 7 patients(18%)the balloon couldn't get a satisfactory pear shape.After treatment,the pain completely disappeared in 17 patients(42%),satisfactory relief of pain was seen in 21 patients(53%),and unsatisfactory relief of pain was observed in 2 patients(5%).The overall effective rate was 95%.The postoperative complications included facial numbness(n=26,65%)and chewing muscle weakness(n=9,23%).Postoperative radiation dose analysis indicated that the mean DAP,CAK and FT in the 40 patients were(79.39±23.15)Gycm^(2),(245.07±84.04)mGy and(5.20±1.30)min,respectively.Conclusion In treating trigeminal neuralgia,C-arm CT-guided PBC can stereoscopically and accurately display the 3D structures of the puncture needle,foramen ov

关 键 词：三叉神经痛 经皮微球囊压迫术 C臂CT 后处理重建 

分 类 号：R745.11[医药卫生—神经病学与精神病学]