CT联合超声引导经圆孔上颌神经射频热凝术治疗V2三叉神经痛

CT combined with ultrasound-guided radiofrequency thermocoagulation of maxillary nerve through foramen rotundum for treatment of V2 trigeminal neuralgia

摘要:

目的： 报道CT联合超声引导经圆孔上颌神经射频热凝术在V2支三叉神经痛（Trigeminal Neuralgia, TN）中的应用，并与CT引导对照，评价该技术方案的精准性、有效性和安全性。方法：回顾南京鼓楼医院医院疼痛医学科2017年1月至2021年3月收治并行经圆孔行上颌神经射频热凝术治疗的V2支TN患者60例，根据引导方式分为CT组（n=41）和CT组联合超声组（n=19）。记录两组穿刺次数、扫描次数、辐射剂量、穿刺时间、手术时间、并发症发生率。观察术前、术后2周、术后4周、术后12周、术后24周NRS评分、BNI评分，计算术后疼痛良好缓解率（BNI：Class I级或II级）。结果：与CT组相比，CT联合超声组穿刺次数和扫描次数更少，辐射暴露更低，穿刺时间和手术时间更短（P<0.05）；与术前相比，两组患者在术后各随访时间点NRS评分均明显改善（P<0.05），各时间点疼痛良好缓解率组间差异无统计学意义；两组面部血肿发生率差异无统计学意义，均无其他严重并发症。结论：CT联合超声引导下经圆孔上颌神经射频热凝术是治疗V2支TN的可行方案，相比CT引导，该方案可以明显提升穿刺精准性并降低治疗相关的辐射暴露。

Abstract:

Objective: To report the application of CT combined with ultrasound-guided radiofrequency thermocoagulation of maxillary nerve through foramen rotundum for treatment of V2 trigeminal neuralgia (TN), and to observe the accuracy, effectiveness and safety of this technique by comparing with CT-guided method. Methods: 60 cases of V2 branch TN patients admitted to pain management department of Nanjing drum tower hospital and treated with radiofrequency thermocoagulation of maxillary nerve through foramen rotundum were reviewed and divided into CT group (n=41) and CT combined with ultrasound group (n=19) according to the guidance methods. The number of puncture, the number of scan, the radiation dose, the puncture time, the operation time and the incidence of treatment complications were recorded and compared between groups. NRS score and BNI score were observed before surgery, 2 weeks, 4 weeks, 12 weeks and 24 weeks after surgery. The rate of good pain relief after surgery (BNI: Class I or II) was calculated. Results: Compared with the CT group, the CT combined with ultrasound group had fewer puncture and scan times, lower radiation exposure, and shorter puncture and surgical time (P<0.05); After surgery, NRS scores in both groups were significantly improved at each follow-up time point (P<0.05). There was no significant difference in the rate of good pain relief at each time point between the groups. There was no significant difference in the incidence of facial hematoma between the two groups. No other serious complications occurred in both groups. Conclusions: CT combined with ultrasound-guided radiofrequency thermocoagulation of maxillary nerve through foramen rotundum is a feasible method for the treatment of V2 branch TN. Compared with CT guidance, this method can significantly improve puncture accuracy and reduce treatment-related radiation exposure.