多层螺旋CT后处理技术在射频热凝治疗三叉神经痛定位中的应用

目的探讨多层螺旋CT MPR重建在射频热凝治疗三叉神经痛定位中的应用。方法对28例三叉神经痛病人,在射频热凝治疗术中应用多层螺旋CT薄层扫描并进行MPR重建,对卵圆孔进行精确定位并调整穿刺针的方向和深度,然后行温控射频热凝治疗。结果穿刺针均位于卵圆孔内,治疗后疼痛即刻缓解,无严重并发症发生。结论多层螺旋CTMPR重建技术引导卵圆孔定位,提高了卵圆孔穿刺的成功率和精确性,增加了操作的安全性,降低并发症发生,可供临床推广应用。     

经皮穿刺射频热凝术治疗第二支三叉神经痛两种方法比较

目的：介绍X线引导下经皮穿刺圆孔与经皮穿刺卵圆孔射频热凝术两种方法及其治疗第二支三叉神经痛的效果。方法：单纯第二支三叉神经痛患者40例,分为圆孔组和卵圆孔组,每组20例,分别行经皮圆孔穿刺和经皮卵圆孔穿刺,明确定位后常规射频治疗。比较两种方法穿刺所用的时间及手术并发症等。结果：所有患者术后疼痛消失,两组穿刺时间的差异无统计学意义（P＞0.05）,圆孔组无手术并发症发生,卵圆孔组有1例上颌神经损伤,3例下颌神经损伤。结论：X线引导下经皮穿刺圆孔和卵圆孔射频热凝术均可用于治疗三叉神经痛,但经皮穿刺圆孔技术定位准确,可降低术后并发症的发生。     

神经导航下射频热凝治疗三叉神经痛的临床研究

目的：探讨神经导航系统在三叉神经痛的射频热凝治疗中的应用。方法：患者术前行CT薄层扫描,将影像学资料输入神经导航系统,将卵圆孔等重要结构标记后行三维重建,在导航引导下进行卵圆孔穿刺后行射频热凝治疗。结果：术中卵圆孔穿刺准确率达100%,术后即刻疗效,优良9例 良好6例,无严重并发症。结论：神经导航术在三叉神经痛射频热凝治疗中的应用提高了穿刺卵圆孔的精确率,减少了手术并发症。     

CT引导下经皮穿刺半月神经节射频热凝术治疗三叉神经痛35例

目的 观察在CT引导下经皮穿刺卵圆孔半月神经节射频治疗原发性三叉神经痛的穿刺成功率及临床效果。方法选择原发性Ⅱ、Ⅲ支三叉神经痛患者35例,CT扫描确定卵圆孔位置及穿刺角度和深度,并给予电生理引导确证,静脉全麻下每分支分别给予65℃和75℃射频热凝各90s。结果所有患者成功经卵圆孔穿刺入半月神经节,射频热凝后7d总有效率97%,随访6个月3例患者复发,复发率为86%.未见明显的严重并发症.结论 CT引导下经皮穿刺卵圆孔半月神经节射频热凝治疗原发性三叉神经痛穿刺成功率高,疗效确切,安全性高.     

三叉神经半月节射频热凝术治疗三叉神经痛50例

目的观察在C形臂引导下经皮穿刺卵圆孔三叉神经半月节射频热凝治疗原发性三叉神经痛的穿刺成功率及临床效果。方法选择原发性三叉神经痛第Ⅱ、Ⅲ支患者50例,以患者颅底CT片确定卵圆孔位置,C形臂下以颞颌关节和瞳孔中点矢状线为参照物引导穿刺卵圆孔三叉神经半月节,以60℃～76℃行射频热凝治疗3.5～5 min。结果所有患者均成功穿刺卵圆孔三叉神经半月节,治疗后7d有效率96%(48/50例),随访4个月未见复发者。未发现明显的严重并发症。结论C形臂引导下经皮穿刺卵圆孔三叉神经半月节射频热凝治疗原发性三叉神经痛穿刺成功率高、疗效确切、安全性高。     

侧方入路半月神经节靶点射频治疗三叉神经痛的效果

目的 探讨经侧方入路三维CT卵圆孔靶点定位,射频热凝治疗三叉神经痛的效果.方法 三叉神经痛患者26例采用本治疗方法,以评估术后治疗效果.结果 本组患者术后优良者21例（80.8％）,好转者5例（19.2％）,未见严重并发症.结论 经侧方入路三维CT引导卵圆孔半月神经节靶点射频热凝术可有效治疗三叉神经痛.     

螺旋CT引导精确穿刺射频温控热凝术治疗经典型三叉神经痛的临床应用

目的探讨螺旋CT引导经卵圆孔穿刺射频温控热凝术治疗经典型三叉神经痛的快速精确穿刺方法。方法收治确诊的经典型三叉神经痛57例,经螺旋cT引导定位,穿刺针经卵圆孔至三又神经半月神经节,进行射频温控热凝治疗。结果所有患者均在短时间内一次性穿刺成功,治疗后7天、3个月疼痛强度评分（NRS）均较术前明显降低（P〈0．05）。三又神经痛完全缓解52例（91．23％）,明确缓解3例（5．26％）,中度缓解2例（3．51％）。无严重并发症。结论螺旋CT引导精确穿刺射频温控热凝术治疗经典型三叉神经痛,定位精确,穿刺快速,确保成功,避免了多次穿刺对针道周围组织的损伤。     

CT定位下射频温控热凝术治疗三叉神经痛疗效分析

目的：探讨CT定位下射频温控热凝治疗原发性三叉神经痛的方法及临床效果。方法：分析用CT引导下经皮穿刺卵圆孔半月神经节,射频温控热凝术（温度设定65～80℃,时间设定为30～60秒治疗三叉神经痛患者32例,对临床资料进行疗效评定。结果：所有操作过程均十分顺利无1例失败。所有患者的疼痛获得缓解,除1例因穿刺起始过程出现血肿外,均无严重的并发症出现。尤其通过C T定位及分层计算,对患者均无第1支的损伤。结论：CT引导下经皮穿刺卵圆孔疗法对三叉神经痛具有定位准确,无痛苦,操作简单、安全,并发症少的优点,具有临床推广应用价值。     

静脉麻醉下射频热凝治疗三叉神经痛的疗效观察

目的：观察在静脉麻醉下对32例三叉神经痛患者行射频热凝治疗的疗效以及不良反应的观察,以指导临床.方法：选择原发性三叉神经痛患者32例,在静脉全麻下行射频热凝治疗.参数设置为毁损模式70℃120 s,80℃120 s,观察术后NRS评分、疼痛缓解率、有效率,以及不良反应的出现.结果：32例患者均在静脉麻醉下顺利穿刺至卵圆孔位置诱发出三叉神经分布区域疼痛后给予射频热凝治疗,平均穿刺时间21rin,术后6月总有效率93.75％（30/32）,无严重并发症出现.结论：CT辅助定位下,卵圆孔显示清晰、客观,在一定程度上也避免了并发症的出现.静脉麻醉避免了疼痛刺激和中枢神经反射,避免了围手术期应激状态,射频热凝对三叉神经痛的治疗经临床证实疗效确切,值得推广.     

半月神经节射频热凝治疗难治性三叉神经痛

目的探讨半月神经节射频热凝治疗难治性三叉神经痛效果和安全性。方法对三叉神经第Ⅱ支合并第Ⅰ、Ⅲ支或Ⅰ、Ⅱ、Ⅲ支并存疼痛者应用改良的前入路卵圆孔穿刺法行射频热凝毁损术。应用C型臂定位下行卵圆孔穿刺。射频温度控制在75-90℃。结果优良46例，良好1例，总有效率为100％。无严重并发症，随访42例3～18个月，无复发患者。结论在C型臂引导下射频热凝半月神经节毁损术治疗难治性三叉神经痛疗效可靠、定位准确，时患者更安全。     

CT引导经皮穿刺半月神经节射频热凝术治疗三叉神经痛的效果与手术技巧

目的总结在CT引导下穿刺半月神经节行标准射频热凝术治疗三叉神经痛患者49例的临床效果和技巧。方法在CT三维或导航引导下对第V颅神经第Ⅱ支痛、Ⅰ＋Ⅱ支痛、Ⅱ＋Ⅲ支痛或Ⅰ＋Ⅱ＋Ⅲ支全痛患者应用改良的Hartel法经前入路卵圆孔穿刺半月神经节,术中验证靶点,并在全身麻醉下进行标准射频靶点温控毁损。结果术后即刻显效,优46例,良2例,差1例,总优良率98．0％（48例）。全组随访,1～6个月内复发率为1．9％（1例）,6个月～1年内复发率为1．9％（1例）。全组均无严重并发症。结论CT引导下穿刺半月神经节行标准射频温控热凝毁损术的疗效可靠、安全,注意手术技巧可减少穿刺过程因深度或方向掌握不当产生的并发症。     

Neuronavigator-guided percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia

Background

Although radiofrequency thermocoagulation is considered as a primary treatment for most patients with trigeminal neuralgia, neuronavigator-guided percutaneous radiofrequency thermocoagulation has been rarely reported. The object of this study was to assess the clinical value of neuronavigator-guided percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia.

Methods

The radiofrequency thermocoagulation was performed in 100 cases of trigeminal neuralgia. The patients were positioned supine or sitting, under Hartel??s technique (reported by Sweet and Wepsic J Neurosurg 40:143?C156, 1974), by anterior lateral facial approaches. The Gasserian ganglions were acupunctured, assisted by intraoperative CT scanning (3-digital reconstruction) and electrophysiology in order to accurately locate target.

Results

The needles located in oval foramen at the first puncture, the direction and position could be defined according to the electrophysiology examination. The pain alleviated immediately after operation. There occurred no serious complication and other nerve injury in all patients despite face numbness only.

Conclusions

3D-CT and electrophysiology Gasser??s ganglion locations can raise the success rate of puncture, enhance the safety and reduce the incidence of complication, showing high academic value and its promising future.     

经卵圆孔射频治疗原发性三叉神经痛的效果

目的观察经卯圆孔射频治疗原发性三叉神经痛的疗效。方法原发性三叉神经痛患者60例,采用射频治疗。在X线下以耳一床线为基线进行定位。结果60例患者中,疗效达优者52例,良5例,好转2例,无效l例。优良率为95％（57／60例）。结论经卯圆孔射频可安全、有效地治疗原发性j叉神经痛。     

THREE-DIMENSIONAL COMPUTED TOMOGRAPHY-GUIDED RADIOFREQUENCY TRIGEMINAL RHIZOTOMY FOR TREATMENT OF IDIOPATHIC TRIGEMINAL NEURALGIA

Objective To evaluate the effectiveness of three-dimensional computed tomography （3D-CT） guided radiofi＇equency trigeminal rhizotomy （RF-TR） in treatment of idiopathic trigeminal neuralgia （1TN）. Methods From 1999 to 2001, 18 patients with ITN were treated with percutaneous controlled RF-TR. Intraoperative 3D-CT scanning was performed to guide the trajectory of the puncture. After correction of the needle tip according to the CT scans and stimulation effects, 2 to 5 lesions were made for a duration of 60-90 seconds at a temperature of 60℃ to 75℃ depending on the pain distribution and the age of patient. The needles located in foramen ovale. Pain alleviated immediately with no serious complication in all patients. The patients were followed up for an average of 31.5 months （range 24-41 months）. Acute pain relief was experienced by 17 patients after the procedure, reaching an initial success rate of 94.4%. Early （〈 6 months） pain recurrence was observed in 2 patients （11.1%）, whereas late （〉 6 months） recurrence was reported in 3 patients （16.7%）. Thirteen patients had complete pain control, with no need for medication thereafter. Five cases experienced partial pain relief, but required medication at a lower dose than in the preoperative period. Conclusion 3D-CT foramen ovale locations can raise the successful rate of puncture, enhance the safety, and reduce the incidence rate of complication.     

数字减影血管造影引导下两种路径射频热凝术治疗原发性三叉神经Ⅱ支痛的临床研究

目的比较数字减影血管造影（DSA）引导下经卵圆孔与经翼腭窝射频热凝术治疗原发性三叉神经11支痛的疗效及并发症。方法原发性三叉神经Ⅱ支痛的患者42例,随机分为两组。A组经卵圆孔入路20例,B组经翼腭窝人路22例,分别在DSA引导下穿刺到目标位置后行射频热凝术,记录治疗前、治疗后1d、3d、2个月、6个月、1年时的视觉模拟评分（VAS）、并发症发生率、复发率及生存质量评分（QOL）。结果两组患者治疗后的VAS评分均较治疗前降低（P〈0．05）;随访1年后,两组患者术后疗效、复发率差异无统计学意义（P〉0．05）;而并发症及QOL。差异有统计学意义（P〈O．05）。结论经两种不同的路径行原发性三叉神经11支痛射频热凝术,疼痛控制均较理想,疗效肯定;但与经翼腭窝人路相比,经卵圆孔入路并发症发生率高,QOL低。     

CT引导下三叉神经半月节射频热凝治疗原发性三叉神经痛临床观察

目的 评价CT引导下三叉神经半月节射频热凝治疗原发性三又神经痛的临床效果.方法 选取原发性三叉神经痛患者30例,经CT定位引导下向患侧卵园孔穿刺至三叉神经半月节,给予阻抗、神经电生理测试后,先行42℃、60 s的自动脉冲射频治疗,再给予80℃、90s,3个周期的射频热凝,术中监测血压、心率、脉搏血氧饱和度.结果 30例原发性三叉神经痛患者经本法治疗后,27例患者疼痛立即消失,随访2～15个月无复发;1例术后1年疼痛复发,1例术后疼痛减轻,另1例完全无效,均无重大并发症发生.结论 CT引导下三叉神经半月节射频热凝是治疗顽固性三叉神经痛的有效手段     

比较不同温度下经卵圆孔射频热凝治疗原发性三叉神经痛的远期疗效

目的比较不同射频温度热凝术治疗原发性三叉神经痛的疗效。方法原发性三叉神经痛患者80例,在C型臂X线机定位下行射频温控热凝术,两组分别逐渐升温至75℃（38例,Ⅰ组）和85℃（42例,Ⅱ组）治疗,比较两组术后的疗效及不良反应。结果术后两组患者VAS评分均下降（P〈0．05）;1年后I组和Ⅱ组优良率分别为89．5％（34／38例）和97．6％（41／42例）,差异有统计学意义（P〈0．05）;Ⅰ组有3例复发,Ⅱ组未见复发。结论85℃射频温控热凝术治疗原发性三叉神经痛患者效果较75℃佳,且无严重并发症。     

Percutaneous microballoon compression for trigeminal neuralgia

Background Percutaneous microballoon compression （PMC） for trigeminal neuralgia is an important therapeutic method. The aim of this study was to review the effects of PMC for trigeminal neuralgia in 276 patients. Methods From December 2000 to May 2003, 276 patients with trigeminal neuralgia were treated with PMC. The course of the disease ranged from 3 months to 38 years. Under the guidance of C-arm X-ray, 14# needle was placed into the foramen ovale using the classical Hakanson＇s technique. Fogarty balloon catheter was navigated into the Meckel＇s cave tenderly. A small amount of Omnipaque was slowly injected to inflate the balloon and compress the trigeminal ganglion for 3 to10 minutes. Results A total of 290 PMC were performed on the 276 patients. Among them, 252 had immediate relief from pain. The patients were followed up for a mean of 18.7 months （range, 4 to 32）, 14 of them had a recurrence. Of the 14 patients, 12 were re-operated with PMC, and the pain was all controlled successfully. Conclusions PMC is an effective and technically simple method for trigeminal neuralgia. For older patients with trigeminal neuralgia, it may be the first choice.