Percutaneous radiofrequency thermocoagulation for trigeminal neuralgia using neuronavigation-guided puncture from a mandibular angle
Percutaneous radiofrequency thermocoagulation for trigeminal neuralgia using neuronavigation-guided puncture from a mandibular angle
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DOI：
10.1097/md.0000000000004940
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发表时间：
2016-10-01
期刊：
影响因子：
1.6
通讯作者：
Yu, Wenhua
中科院分区：
文献类型：
--
作者：
Ding, Weihua;Chen, Shuping;Yu, Wenhua
经皮射频热凝术（RFT）是治疗原发性三叉神经痛（pTN）的有效方法。Hartel前路是目前最常用的进入半月神经节的方法。然而，这种方法与高复发率和技术困难，在某些患者与卵圆孔（FO）解剖变异。为探讨CT引导下经下颌角入路进入半月神经节的可行性，将108例TN患者随机分为G组和H组。在H组中，使用Hartel前路穿刺FO;而在G组中，使用经下颌角经皮穿刺到达FO。在两组中，手术均由CT成像和神经导航引导。比较两组穿刺成功率、疗效、并发症及复发率，H组穿刺成功率为52/54（96.30%），G组穿刺成功率为49/54（90.74%）（P=0.24）。H组2例手术失败采用颌下轨迹法修复，G组5例手术失败采用Hartel法修复。治疗后36个月时，巴罗神经研究所（BNI）疼痛评分（P=0.03）和生活质量（QOL）评分（P=0.04），G组疗效明显优于H组。H组1/54例（1.85%）发生血肿，G组未观察到血肿病例（P=0.33）。H组27/52例（51.92%）患者RFT导致三叉神经非预期分支和运动纤维损伤，G组7/49例（14.29%）患者RFT导致非预期分支和运动纤维损伤（P
Percutaneous radiofrequency thermocoagulation (RFT) of the Gasserian ganglion is an effective treatment for primary trigeminal neuralgia (pTN). Currently Hartel anterior approach is the most commonly used method to access the Gasserian ganglion. However, this approach is associated with high recurrence rate and technical difficulties in certain patients with foramen ovale (FO) anatomical variations. In the present study, we assessed the feasibility of accessing the Gasserian ganglion through the FO from a mandibular angle under computed tomography (CT) and neuronavigation guidance.A total of 108 patients with TN were randomly divided into 2 groups (Group G and Group H) using a random number table. In Group H, Hartel anterior approach was used to puncture the FO; whereas in Group G, a percutaneous puncture through a mandibular angle was used to reach the FO. In both groups, procedures were guided by CT imaging and neuronavigation. The success rates, therapeutic effects, complications, and recurrence rates of the 2 groups were compared.The puncture success rates in Group H and Group G were 52/54 (96.30%) and 49/54 (90.74%), respectively (P=0.24). The 2 procedural failures in Group H were rescued by using submandibular trajectory, and the 5 failures in Group G were successfully reapproached by Hartel method. Therapeutic effects as measured by Barrow Neurological Institute (BNI) pain scale (P=0.03) and quality of life (QOL) scores (P=0.04) were significantly better in Group G than those in Group H at 36 months posttreatment. Hematoma developed in 1/54 (1.85%) cases in Group H, and no cases of hematoma were observed in Group G (P=0.33). In Group H, RFT resulted in injury to the unintended trigeminal nerve branches and motor fibers in 27/52 (51.92%) cases; in Group G, it resulted in the same type of injury in 7/49 cases (14.29%) (P