CT-Guided Percutaneous Infrazygomatic Radiofrequency Neurolysis Through Foramen Rotundum to Treat V2 Trigeminal Neuralgia
CT-Guided Percutaneous Infrazygomatic Radiofrequency Neurolysis Through Foramen Rotundum to Treat V2 Trigeminal Neuralgia
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DOI：
10.1111/pme.12440
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发表时间：
2014-08-01
期刊：
影响因子：
3.1
通讯作者：
Qian, Xiang
中科院分区：
文献类型：
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作者：
Huang, Bing;Yao, Ming;Qian, Xiang
objective.经卵圆孔射频热凝或松解半月神经节是治疗三叉神经痛的经典方法。然而，当需要通过这种方法进行单个三叉神经分支神经阻滞时，在技术上具有挑战性。因此，我们开发了一种新的计算机断层扫描引导技术，通过Rotamen（FR）阻滞V2三叉神经。利用这种技术，我们对27例孤立性V2 TN患者进行了研究。我们假设这种新技术的临床结果与传统FO入路相当。前瞻性研究。设置。学术医院。主题。27例孤立性经典V2型TN患者分为FO组（N = 12）和FR组（N = 15）。记录治疗前、术后即刻、术后1天、1个月、6个月和12个月时面部疼痛的数字评定量表（NRS）评分。比较并分析主要临床结局（疼痛缓解成功，NRS减少50%或以上）和次要不良临床结局（血肿、面部麻木、咀嚼无力和角膜受累）。两组都有良好的即时和持续的疼痛缓解。然而，与FO组相比，FR组的手术时间更短（29.2 +/-9.3 vs 45.4 +/-22.13分钟，P <0.05），在V1和V3皮区具有较少的非特异性阻滞，不良反应包括咀嚼无力（0/15 vs5/12）和角膜穿孔（0/12 vs1/15）较少。我们已经开发了一种新的技术，选择性地阻滞V2三叉神经在FR。这种新的FR方法可能是一个很好的替代经典的FO方法时，孤立的V2分支阻滞是必要的。
Objective. Percutaneous radiofrequency thermocoagulation or neurolysis of Gasserian ganglion through foramen ovale (FO) is the classical approach to treat trigeminal neuralgia (TN). However, it has been technically challenging when individual trigeminal sub-branch nerve block is desired through this approach. We have thus developed a novel computed tomograph-guided technique to block the V2 trigeminal nerve through foramen rotundum (FR). With this technique, we have conducted a study of 27 patients with isolated V2 TN. We hypothesize that this new technique will have comparable clinical outcome with the conventional FO approach.Design. Prospective study.Setting. Academic hospitals.Subjects. Twenty-seven patients with isolated classical V2 TN were enrolled and divided into FO group (N = 12) and FR group (N = 15).Methods. Numeric Rating Scale (NRS) scores for facial pain, at pretreatment, immediate postoperative, postoperative 1 day, and 1, 6, and 12 months were recorded. The primary clinical outcome (successful pain relief with 50% or more reduction in NRS) and secondary adverse clinical outcome (hematoma, facial numbness, masticatory weakness, and corneal involvement) were compared and analyzed.Results. Both groups have good immediate and sustained pain relief. However, when compared with the FO group, the FR group is associated with shorter procedural time (29.2 +/- 9.3 vs 45.4 +/- 22.13 minutes, P < 0.05), has less nonspecific block in V1 and V3 dermatomes, and has fewer adverse outcomes including masticatory weakness (0/15 vs 5/12) and corneal perforation (0/12 vs 1/15).Conclusions. We have developed a novel technique to selectively block the V2 trigeminal nerve at FR. This novel FR approach may be a good alternative to the classical FO approach when an isolated V2 branch block is desired.