CT引导下三叉神经出颅孔道穿刺射频消融在三叉神经痛治疗中的应用

doi:10.3760/cma.j.cn101202-20230201-00030

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摘要目的探讨CT引导下颅外非半月神经节射频消融治疗三叉神经痛技术的临床应用效果。方法横断面研究。纳入2013年1月—2022年12月嘉兴市第一医院、海宁市第二人民医院和杭州市红十字会医院疼痛科原发性三叉神经痛患者1 213例,其中男722例、女491例,年龄31~103（64.3±7.6）岁。疼痛位于三叉神经第Ⅰ支、第Ⅱ支、第Ⅲ支、第Ⅰ+Ⅱ支、第Ⅱ+Ⅲ支、第Ⅰ+Ⅱ+Ⅲ支者分别为188、312、447、63、176、27例,均接受颅外非半月神经节射频治疗,分别在CT引导下经皮穿刺至患侧眶上孔、圆孔、卵圆孔、眶上孔+圆孔、圆孔+卵圆孔和眶上孔+圆孔+卵圆孔,电生理测试确认后对责任神经分支给予95 ℃、180s射频消融治疗。疗效评估：以术后发作性疼痛消失且至少持续1个月不发作为治愈,以术后仍有疼痛发作但发作时疼痛视觉模拟评分法（VAS）评分较术前降低25%以上为有效,且治疗有效患者术后第3天再次行射频消融治疗后疼痛发作消失者仍记为治愈;记录术中、术后并发症;观察三叉神经痛复发率,以治愈1个月以上再次出现发作性三叉神经痛为复发。结果本组1 213例均治愈,患者原疼痛区均遗留明显的皮肤感觉麻木：其中1 153例经一次射频消融治疗后痊愈,术后第2天未再出现发作性疼痛;另60例一次射频消融治疗后第2天仍有疼痛发作,但发作时VAS评分由术前的5~9（6.43±2.31）分下降至4~6（3.72±0.46）分,下降幅度均>25%,显示治疗均有效,于术后第3天予以再次射频消融治疗后均治愈。全组患者围术期均无心、脑血管意外事件发生,无穿刺部位或颅内感染,无非疼痛区域感觉减退;其中94例术后面部肿胀,经序贯冷、热敷3 d肿胀渐消退。原疼痛累及第Ⅲ支的650例患者术后均有不同程度的张口困难和咀嚼无力,患侧颊、舌黏膜感觉减退,上下牙列对位稍不齐。本组1 213例患者术后随访0.5~10年, 1年、3年、5年、10年复发率分别为7.3%（79/1 082）、19.2%（132/687）、31.8%（125/393）、51.4%（38/74）。结论将三叉神经痛的射频消融治疗靶点由颅内半月神经节转移至各分支出颅孔道是安全、可行的,且临床疗效较好。

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	褚丹涛
	杜鑫丹
	邢伟
	黄冰

关键词 ：三叉神经痛, 射频消融术, CT引导, 出颅孔道穿刺, 眶上孔, 圆孔, 卵圆孔

Key words： Trigeminal neuralgia Radiofrequency ablation CT-guided Puncture through the exit cranial canal Supraorbital foramen Foramen rotundum Foramen ovale

收稿日期: 2023-02-01

基金资助:浙江省医药卫生平台重点项目（2016ZDA018）; 海宁市科技计划（2020092）

通讯作者: 黄冰,Email：jxhb999@sina.com

引用本文:

褚丹涛, 杜鑫丹, 邢伟, 黄冰. CT引导下三叉神经出颅孔道穿刺射频消融在三叉神经痛治疗中的应用[J]. 中华解剖与临床杂志, 2023, 28(10): 686-690.
Chu Dantao, Du Xingdan, Xing Wei, Huang Bing. Radiofrequency ablation of CT-guided puncture through the exit cranial canal of trigeminal nerve branches in the treatment of trigeminal neuralgia. Chinese Journal of Anatomy and Clinics, 2023, 28(10): 686-690.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20230201-00030 或 http://www.cjac.com.cn/CN/Y2023/V28/I10/686

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