颈部CTA辅助茎突、寰椎横突CT定位穿刺射频治疗舌咽神经痛

Cervical CTA assisted CT guided puncture localization by atlas transversal process and styloid process for radiofrequency ablation in the treatment of glossopharyngeal neuralgia

摘要:

目的 观察颈部计算机断层扫描血管造影（CTA）辅助CT引导下寰椎横突和茎突定位穿刺射频治疗舌咽神经痛的临床效果。方法 先对确诊的31例舌咽神经痛患者术前做颈部CTA，并在CTA图片上选择穿刺层面并预设计穿刺路径。术中参照术前所设计穿刺路径在CT引导下将祼露端5mm的专用钝头射频穿刺针穿刺至靶点，用高（50Hz）、低（2Hz）频电流（0.5~1mA）测试，咽部和/或内耳原疼痛区有异感则认为检测到舌咽神经（舌咽神经测试阳性），若无迷走神经、副神经受激惹征象时，则依次给予70℃60s、80℃60s、90℃60s射频消融治疗。记录首次穿刺达靶点的时间、首次测试阳性率、测试寻找到舌咽神经时间、调整射频针位置次数，术中、术后并发症发生情况及治疗效果。结果 所有患者均依术前设计穿刺路径穿刺至靶点，穿刺深度和角度分别为4.04±0.44cm和 17.84±3.9度，射频针首次穿刺至靶点时间为5.82±1.51min，首次穿刺至靶点后电生理测试舌咽神经异感率（74.2%，23/31）、8例经（1.24±1.30）次调整穿刺针尖位置即可测试出阳性结果、测试花费总时间(17.88±17.81)min，单次射频治疗有效率71%（22/31）。治疗期间有3例因出现声音嘶哑，饮水呛咳而终止射频，所有患者均无颈部血肿或死亡事件发生。结论 术前颈部CTA辅助寰椎横突和茎突CT定位，以寰椎横突下缘水平的茎突后内侧、颈内动脉表面（前内侧缘）作为舌咽神经痛的射频治疗靶点易找到舌咽神经，在该靶点行70-90℃180s射频消融治疗舌咽神经痛时单次射频有效率高达70%以上，值得临床推广应用。

Abstract:

Objective To evaluate the efficacy of Cervical computed tomography angiography (CTA) assisted CT-guided radiofrequency puncture via the transverse process and styloprocess in the treatment of glossopharyngeal neuralgia. Methods Cervical CTA was performed prior to surgery in 31 patients diagnosed with glossopharyngeal neuralgia，and select the puncture plane on the CTA picture and pre-design the puncture path.During the operation, under the direction of CT, a specialized blunt radiofrequency puncture needle with a bare end of 5mm was punctured into the target point ,following the pre-designed puncture path.Test with high frequency (50Hz) and low frequency (2Hz) currents (0.5-1mA),The glossopharyngeal nerve is considered to have been detected if there is a distinct sensation in the original pain area (glossopharyngeal nerve test was positive).If there are no signs of irritation of the vagus and accessory nerves,the patients were treated with radiofrequency ablation at 70℃ for 60s, 80℃ for 60s, and 90℃ for 60s in turn.The time to reach the target of the first puncture, the positive rate of the first test, the time to find the glossopharyngeal nerve in the test, The times of adjusting the position of the radiofrequency needle, the occurrence of intraoperative and postoperative complications and the therapeutic effect were recorded. Results All patients were punctured to the target according to the preoperative designed puncture path.The puncture depth and angle were 4.04±0.44cm and 17.84±3.9 °.The time from the first puncture to the target was 5.82±1.51 min.After the first puncture to the target, the electrophysiological test showed that the glossopharyngeal nerve abnormal sensation rate was 74.2% (23/31),the positive results could be detected by (1.24±1.30) times of adjusting the position of the puncture needle in 8 cases，The total test time was (17.88±17.81) min, and the effective rate of single radiofrequency treatment was 71% (22/31).During the treatment, 3 patients discontinued radiofrequency because of hoarseness and water choking . No neck hematoma or death occurred in all patients. Conclusion It is easy to find the glossopharyngeal nerve by preoperative cervical CTA assisted CT localization of the transverse process and styloid process of atlas,and using the posteromedial side of the styloid process and the surface of the internal carotid artery (anteromedial border) at the level of the lower edge of the transverse process of atlas as the target of radiofrequency treatment of glossopharyngeal neuralgia.Radiofrequency ablation at 70-90℃ for 180s in the treatment of glossopharyngeal neuralgia has an effective rate of more than 70%, which is worthy of clinical application.