CT引导下半月节射频热凝治疗顽固性三叉神经痛

目的探讨CT引导下半月节射频热凝治疗顽固性三叉神经痛的疗效。方法 2007年3月～2010年12月,在CT引导下对68例常规口服药物治疗无效的三叉神经痛进行经皮穿刺半月节射频热凝治疗,三叉神经第Ⅰ支9例,第Ⅱ支12例,第Ⅲ支17例,第Ⅰ＋Ⅱ支3例,第Ⅱ＋Ⅲ支24例,第Ⅰ＋Ⅱ＋Ⅲ支3例。结果 68例均于CT引导下穿刺进入相应卵圆孔。66例治疗后疼痛消失,1例减轻,1例无效。68例随访3～48个月,平均31个月,5例复发,复发率7.4%。1例三叉神经第Ⅰ支射频术后同侧眼球结膜充血,2周后角膜溃疡,8周后溃疡穿孔,10周后穿孔自行愈合,但该眼视力丧失。结论 CT引导下半月节射频热凝能有效治疗顽固性三叉神经痛。对于三叉神经第Ⅰ支的射频治疗,一定要控制热凝温度于70℃以下,严密监测射频过程中患者的角膜反射,做到角膜反射迟钝即结束治疗。     

C臂机引导下经皮穿刺半月神经节射频温控热凝毁损术治疗三叉神经痛

目的总结在C臂机引导下经皮穿刺卵圆孔三叉神经半月神经节热凝治疗三叉神经痛78例的穿刺方法和效果。方法选择三叉神经痛第II、III支患者78例,在C臂机引导下经前入路卵圆孔穿刺半月神经节,术中验证电极到达半月神经节后,对半月神经节行射频温控热凝毁损治疗。结果术后即刻显效,优63例(80.8%),良13例(16.7%),无效者2例(2.6%),总有效率97.4%(76/78)。无脑脊液漏等严重并发症发生。术后随访6个月~2 a,76例治疗效果优良的患者未见复发。结论在C臂机引导下经皮穿刺卵圆孔三叉神经半月神经节射频温控热凝毁损治疗三叉神经痛,成功率高、效果好,并发症少,复发率低、安全。     

CT定位选择性射频热凝术治疗原发性三叉神经痛

目的探讨CT定位选择性三叉神经半月节射频热凝术治疗原发性三叉神经痛的临床价值。方法选择24例原发性三叉神经痛，Hartel前入路穿刺法，局麻CT定位下经卵圆孔穿刺三叉神经半月节，经电生理验证后温控射频热凝对靶点进行选择性毁损治疗。结果疼痛消失18例，疼痛减轻5例，无缓解1例，总有效率95、8％（23／24）。24例随访3～18个月，平均12个月。2例（8、3％）复发。结论CT定位选择性三叉神经半月节射频热凝术治疗原发性三叉神经痛安全简便，疗效可靠，并发症少，尤其适用于高龄或不能耐受开颅手术的病人。     

诊断性阻滞在三叉神经半月节射频热凝术中的临床评价

目的探讨诊断性阻滞在三叉神经半月节射频热凝术中的临床应用价值。方法将160例原发性三叉神经痛按就诊顺序随机分为2组,A组为非诊断性阻滞组（n=80）,B组为诊断性阻滞组（n=80）。A组患者不进行诊断性阻滞直接入院治疗,B组患者入院前行三叉神经半月节诊断性阻滞。2组患者入院后均在C形臂X线机引导下行三叉神经半月节射频热凝治疗。2组患者疼痛评估采用视觉模拟评分法（VAS）,穿刺针尾有新鲜血液流出视为穿刺出血,记录诊断性阻滞阴性率,穿刺次数及穿刺出血率。结果B组诊断性阻滞阴性3例,占3.8%（3/80）。2组比较VAS评分各时段无统计学差异（P〉0.05）。治疗中B组一次穿刺到位率明显高于A组（69例vs.24例,χ^2=57.738,P=0.000）,穿刺出血率显著低于A组（6例vs.17例,χ^2=5.683,P=0.017）。结论经皮穿刺三叉神经半月节射频热凝术前通过诊断性阻滞的诊断和定位,对于提高射频热凝的毁损效果并无明确帮助,但诊断性阻滞本身可以保证诊断的准确性,防止误毁损的发生,提高穿刺的准确性与成功率,有效减少反复穿刺导致的风险。     

CT引导下半月神经节射频热凝术治疗三叉神经痛

三叉神经痛系三叉神经分布区内反复发作阵发性剧痛的一种疾病，原因不明，也可继发于其他疾病。是常见的疼痛性疾病，严重影响患者的生活质量。该病的诊断容易，治疗较困难。一般的患者可以采用口服药物治疗，药物治疗无效的重度患者可选择半月神经节化学毁损术、射频热凝毁损术和微球囊压迫术。其中，半月神经节射频热凝术的创伤较轻，疗效确切。但由于卵圆孔位置较深，解剖变异较大，     

CT引导下射频热凝术治疗三叉神经痛的疗效观察

目的:观察CT引导下行射频热凝治疗三叉神经痛的160例患者的疗效.方法:将160例确诊为三叉神经痛患者随机分为对照组与观察组各80例,对照组行药物治疗,观察组采用射频热凝三叉神经痛治疗,评估两组疗效、治疗前后视觉模拟评分(VAS).结果:观察组患者治疗后VAS下降,差异有统计学意义(P＜0.05),并且观察组VAS评分较对照组明显(P＜0.05).结论:射频热凝术治疗三叉神经痛疗效确切,是一种有效的治疗方法,值得临床应用推广.     

射频热凝治疗三叉神经痛并发症分析

本院自2000年1月至2003年1月共收治三叉神经痛、用射频热凝治疗53例,效果满意,也出现了一些并发症.现结合文献,作一些探讨.     

CT引导下射频热凝术治疗原发性三叉神经痛的疗效观察

目的:探讨CT引导下行射频热凝治疗原发性三叉神经痛的临床效果.方法:将184例原发性三叉神经痛的患者在CT引导下行射频热凝治疗结果,副作用及并发症进行比较,结论:CT引导下行射频热凝治疗原发性三叉神经痛具有疗效好,安全性高,副作用少等优点,值得推广.     

射频治疗原发性三叉神经痛36例临床分析

目的探讨射频热凝术治疗原发性三叉神经痛患者的临床效果。方法将72例原发性三叉神经痛患者按照随机、自愿的原则分为对照组和观察组,每组各36例。对照组采用药物或者封闭治疗,观察组给予射频热凝术治疗。比较两组的治疗效果。结果观察组患者总有效率明显高于对照组,差异有统计学意义(P0.05)。术后随访6个月,对照组有4例(11.1%)复发,观察组有1例(2.7%)复发,观察组复发率明显低于对照组,差异有统计学意义(P0.05)。结论射频热凝术治疗原发性三叉神经痛患者临床效果显著,值得推广应用。     

CT引导下经皮圆孔穿刺射频温控热凝术治疗三叉神经痛(第Ⅱ支)的疗效及安全性

目的探讨薄层CT引导下经皮穿刺圆孔射频热凝术治疗药物无效或复发性三叉神经痛(第Ⅱ支)的疗效及安全性。方法对药物无效或复发性三叉神经痛(第Ⅱ支)的22例患者行CT引导下经皮穿刺圆孔射频热凝术治疗,采用巴罗神经学研究所(BNI)分级评定标准评价患者术后疗效,观察术后并发症情况。结果 22例患者术后即刻疼痛完全缓解率达95.45%(21/22),1例患者术后疼痛有所缓解,但服药后可以控制(BNI分级Ⅲ级)。2例患者术后复发,均再次行射频术,术后即刻疼痛均完全缓解(BNI分级Ⅰ级)。随访3~19个月,平均(7.73±4.69)个月。所有患者均无任何严重并发症发生。结论薄层CT引导下经皮穿刺圆孔射频热凝治疗药物无效或复发性三叉神经痛(第Ⅱ支)的疗效可靠、并发症少,可作为药物无效或复发性三叉神经痛的一种理想微创治疗手段。     

Alterations of facial sensitivity induced by percutaneous thermocoagulation for trigeminal neuralgia

Sixty patients with essential trigeminal neuralgia underwent selective percutaneous thermocoagulation of the gasserian ganglion. Immediate and long-term modifications of pain and tactile facila sensitivity, recurrences of pain, and occurrences of facial paresthesias were evaluated. Pin-prick and von Frey hair tests and somatosensory-evoked potentials were used to study facila sensitivity. Patients with mild alterations of sensitivity-treated with low temperatures of coagulation (60°–70°C)-had a lower incidence of paresthesias, although a higher risk of recurrence. Patients with severe alterations of sensitivity–a consequence of a temperature of coagulation above 70°C—had a high incidence of paresthesias and a low risk of recurrence. In our opinion, the first kind of results are better.     

神经导航下经皮选择性半月神经节内靶点射频术治疗三叉神经痛的效果

目的 评价神经导航下经皮选择性半月神经节内靶点射频术治疗三叉神经痛的效果.方法 原发性三叉神经痛患者147例,性别不限,年龄32～99岁,VAS评分＞8分.采用随机数字表法,将患者分为2组:C型臂组(C组,n =72)和神经导航组(N组,n=75).C组采用Hartel前入路穿刺法,C型臂引导下以卵圆孔为靶点进行穿刺;N组将头颅MRI影像传输至StealthStation手术导航系统进行重建,在半月神经节内确定靶点位置后设计穿刺径路和穿刺点.记录穿刺成功情况和穿刺及射频术相关不良事件发生情况.分别于术后1d、7d、1个月、6个月、12个月、24个月记录VAS评分,并根据VAS评分评价镇痛效果,术后1、24个月根据Barrow神经研究所评分系统评价治疗效果.结果 N组无一例患者发生穿刺相关不良事件及动眼神经损伤和耳鸣.与C组比较,N组首次手术穿刺成功率升高,术后不同时点镇痛有效率升高,治疗效果较好(P＜0.05),神经定位时间和面部麻木发生率差异无统计学意义(P＞0.05).结论 神经导航下经皮选择性半月神经节内靶点射频术治疗三叉神经痛的治疗效果好,复发率低,穿刺成功机率高,且并发症少.     

Long-term outcome of percutaneous thermocoagulation for trigeminal neuralgia

A retrospective analysis of long-term efficacy of percutaneous radiofrequency thermocoagulation of the trigeminal ganglion or root for the relief of trigeminal neuralgia was carried out in our unit. From the medical records and questionnaires, outcomes of 108 procedures performed in 81 patients from January 1986 to December 1990 were obtained with a follow-up period of 6-11 years. The initial success rate was 87% and the probability of remaining pain-free 1, 2 and 11 years after the procedure was 65, 49 and 26%, respectively. Patients with typical symptoms had a better long-term efficacy than those with atypical presentations, and patients who had not undergone a previous surgical procedure also had a better outcome. There was no mortality in this series. Common adverse effects included dysaesthesia in 20 patients, corneal numbness in 12 patients and masseter weakness in three patients.     

Patient's assessment of outcome after three surgical procedures for the management of trigeminal neuralgia

Summary Four hundred and seventy five patients with trigeminal neuralgia underwent cryotherapy (145), radiofrequency thermocoagulation (265) or microvascular decompression 65) and were then followed up for mean time of 45 months. Outcome of treatment was assessed not only by the clinicians but also by a postal questionnaire. The presence of anxiety and depression was determined and compared to 51 patients due to undergo surgery.The median time to recurrence for the cryotherapy patients and the radiofrequency thermocoagulation patients were 6 and 24 months, respectively. At 5 years 38% of the microvascular decompression patients had had a recurrence of neuralgia. There was one operative death in the radiofrequency thermocoagulation group. Patients in all three groups were satisfied with their treatment but the questionnaires showed that clinicians under-report the recuccrence of pain and post operative complications. Pre-operatively depression and anxiety are high but post-operatively only 15% were depressed.Patients need careful pre-operative assessment which includes the McGill Pain Questionnaire and they should be given a choice about which surgical method would be most suitable in their case. Printed information should be available to supplement the consultation. This would ensure the patients' expectations matched up with the results as they would be aware of possible outcomes.     

微血管减压术治疗三叉神经痛

目的 探讨微血管减压术治疗原发性三叉神经痛的安全有效性。方法 回顾分析微血管减压术治疗13例原发性单侧三叉神经痛的临床资料。术前采用SE序列及三维稳态旋进快速成像(3-Dfast inflow with steady—state precession)序列进行MR扫描，手术采用乙状窦后入路，分离血管神经后用人造血管补片隔离。结果 术中见所有三叉神经均受到血管压迫，11例为小脑上动脉压迫，1例为基底动脉和小脑上动脉压迫，1例为静脉压迫。术后疼痛完全消失，无手术死亡及永久性并发症。随访11例，时间6月～24月，平均13月，无疼痛复发。结论 微血管减压术治疗原发性三叉神经痛是安全有效的。     

Radiofrequency percutaneous gasserian ganglion lesions in the treatment of trigeminal neuralgia

Summary Technical procedures of selective controlled thermocoagulation of the trigeminal preganglionic rootlets and gasserian ganglion are discussed. The possibility of physiologic stimulation and intraoperative patient monitoring for the performance of graded lesion-making is presented. Experiences in 426 patients with trigeminal neuralgia (293 patients were taken for statistical analysis) is demonstrated. A survey of complications compared with other surgical treatments is presented.     

强化三维损毁梯度回波序列在三叉神经痛微血管减压术前评价中的作用

目的 研究强化三维损毁梯度回波序列(3D-SPGRI)在三叉神经痛微血管减压(MVD)术前评价和病例选择中的作用.方法 33例三叉神经痛患者行高分辨率强化3D-SPGRI及三维脑血管成像(3D-MRA)扫描,观察三叉神经出脑干段神经及邻近血管关系,并与MVD术中观察结果 对比.结果 33例患者中29例显示与疼痛侧别一致的神经血管接触或压迫并行显微手术减压,手术证实,其中27例MR图像符合术中所见,所有手术患者术后疼痛完全缓解.结论 3D-SPGRI结合3D-MRA能够清晰显示脑池段三叉神经及其邻近血管,为MVD术前评价、病例选择、判断预后提供有价值的信息.     

Percutaneous thermocoagulation for sphenopalatine ganglion neuralgia

Summary The authors describe percutaneous radiofrequency (rf) thermocoagulation of the sphenopalatine ganglion used to treat seven patients with sphenopalatine ganglion neuralgia.The procedure was effective in relieving pain, without significant side-effects. All the patients have actually been free of pain during a follow-up of 6–28 months. The surgical technique and the rationale for its use are pointed out.