Identification of Foramen Ovale With H-Figure Fluoroscopic Landmark Improves Treatment Outcomes in Idiopathic Trigeminal Neuralgia.
Identification of Foramen Ovale With H-Figure Fluoroscopic Landmark Improves Treatment Outcomes in Idiopathic Trigeminal Neuralgia.
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DOI：
10.1213/ane.0000000000005992
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发表时间：
2022-10-01
影响因子：
5.7
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由于传统上通过荧光透视识别卵圆孔（FO）是困难和耗时的，我们最近开发了H图方法来获取FO的荧光透视视图，具有更短的手术时间和更少的辐射。然而，这种H形方法对三叉神经节射频热凝（RFT）治疗特发性三叉神经痛（ITN）的临床结局的影响尚不清楚。在一项12个月随访回顾性队列研究中，ITN患者通过经典方法（n=100）或H形方法（n=136）进行三叉神经节透视引导RFT以识别FO。对连续变量数据进行Shapiro-Wilk正态性检验，然后进行Mann-Whitney检验，对二元数据进行卡方检验。主要结果是治疗后1年通过视觉疼痛量表（VAS）测量的面部疼痛。次要结局包括透视FO视图的质量、引起感觉异常的阈值电压、手术时间、透视图像数量和面部麻木VAS。与经典方法组相比，H形方法组术后长期疼痛缓解更好，3个月疼痛的患者明显减少（6.6% vs 17.0%，p=0.012）和12个月（21.3% vs 38.0%，p=0.005），在术后疼痛的患者中，术后6个月，H形组患者的疼痛明显减轻（VAS中位数[IQR]：3 [2-6] vs 6 [4-7]，p<0.001）。此外，与经典方法相比，H形方法提供了更好的FO透视视图，引起感觉异常的阈值电压更低（中位数[IQR]：0.2 [0.2-0.3] vs 0.4 [0.4-0.5] V，p<0.0001），手术时间更短（中位数[IQR]：7.5 [6.0-9.0] vs 14.0 [10.0-18.0] min，p<0.0001），并且需要较少数量的荧光透视图像（中位数[IQR]：4.0 [3.0-5.0] vs 8.0 [6.0-10.0]，p<0.0001）。在治疗ITN中，使用H形入路的三叉神经节RFT与上级长期临床疼痛缓解相关，优于经典方法。
Because it is traditionally difficult and time-consuming to identify the foramen ovale (FO) with fluoroscopy, we recently developed the H-figure method to acquire fluoroscopic view of FO with shorter procedure time and less radiation. However, the impact of such H-figure approach on the clinical outcomes of trigeminal ganglion radiofrequency thermocoagulation (RFT) in treating idiopathic trigeminal neuralgia (ITN) remains unclear. In a 12-month follow-up retrospective cohort study, patients with ITN had fluoroscopy-guided RFT of trigeminal ganglion via either classic approach (n=100) or H-figure approach (n=136) to identify FO. Data of continuous variables were analyzed with Shapiro-Wilk test for normality and subsequently with Mann-Whitney test, and the binary data were analyzed with Chi-square test. The primary outcome was the facial pain measured by Visual Analogue Scale (VAS) at one year after the treatment. The secondary outcomes included the quality of the fluoroscopic FO views, the threshold voltage to provoke paresthesia, the procedure time, the number of fluoroscopic images, and the facial numbness VAS. Compared with the classic approach group, the H-figure approach group was associated with better long-term pain relief after the procedure, with significantly less patients had pain 3 months (6.6% vs 17.0%, p=0.012) and 12 months (21.3% vs 38.0%, p=0.005) after the procedure, and among patients who had pain after the procedure, patients in H-figure group had significantly less pain 6 months after the procedure (VAS median [IQR]: 3 [2–6] vs 6 [4–7], p<0.001). Moreover, compared to the classic approach, the H-figure approach provided better fluoroscopic view of FO, lower threshold voltage to elicit paresthesia (median [IQR]: 0.2 [0.2–0.3] vs 0.4 [0.4–0.5] V, p<0.0001), with shorter procedure time (median [IQR]: 7.5 [6.0–9.0] vs 14.0 [10.0–18.0] min, p<0.0001), and required less number of fluoroscopic images (median [IQR]: 4.0 [3.0–5.0] vs. 8.0 [6.0–10.0], p<0.0001). RFT of the trigeminal ganglion using the H-figure approach is associated with superior longer term clinical pain relief than the classic approach in treating ITN.