三叉神经射频的疗效分析与半月节解剖差异特点回顾

Assessment of radiofrequency outcome for trigeminal neuralgia and retrospective analysis of anatomical variation of gasserian ganglion

摘要:

目的：回顾分析三叉神经射频疗效与半月节解剖变异特点的关系。方法：回顾2018年至2019年我科诊断为三叉神经痛,行半月节射频术的患者。采用Radiant软件对O形臂扫描结果进行术后重建,分析射频穿刺路径与半月节解剖变异特点,并与卵圆孔穿刺射频即刻疗效进行对比。结果：纳入研究患者41人,术后即刻疼痛消失30人(73.1%),疼痛减轻7人(17.1%),无效4人(9.8%),上述4例无效及7例减轻的患者中9例均为第Ⅱ支范围疼痛控制不满意。回顾分析其半月节解剖特点均发现,经卵圆孔穿刺射频由于穿刺角度所限,不能完全进入半月节,推测是不能覆盖第Ⅱ支范围导致射频效果不佳的原因。结论：三叉神经痛患者行卵圆孔穿刺射频,特别是累及第Ⅱ支疼痛患者有时效果不佳,可能是由于半月节解剖差异导致,可同期行圆孔穿刺射频。

Abstract:

Objective: To retrospectively analyze the relationship between the outcome of radiofrequency rhizotomy of the trigeminal nerve and the anatomical variation of the gasserian ganglion. Methods: From 2018 to 2019, patients with diagnosis of trigeminal neuralgia in our department were retrospectively reviewed, who underwent O-arm intro-operative scan and radiofrequency rhizotomy were enrolled. Radiant software was used to reconstruct the results of O-arm scan after operation. The characteristics of radiofrequency puncture path and anatomical variation of the gasserian ganglion were analyzed, and the results were compared with outcome of foramen ovale puncture radiofrequency. RESULTS: Among the 41 patients included in the study, 30 (73.1%) had immediate pain relief, 7 (17.1%) had moderate pain relief and 4 (9.8%) had no effect. Nine of the moderate relief and no effect patients were unsatisfactory in pain control of branch II. Retrospective analysis of the anatomical characteristics of the gasserian ganglion revealed that the radiofrequency puncture through the foramen ovale could not enter the gasserian ganglion completely due to the limited puncture angle. It was speculated that the reason for the poor outcome of radiofrequency was the territory of branch II could not be covered. CONCLUSION: Radiofrequency rhizotomy through foramen ovale puncture in patients with trigeminal neuralgia, especially in patients with pain of the second branch, is sometimes ineffective. It may be due to the anatomical differences of the gasserian ganglion, and can be performed simultaneously by radiofrequency via foramen ovale puncture.