神经导航引导下经皮射频热凝术治疗顽固性三叉神经痛
Neuronavigator-guided percutaneous radiofrequency thermocoagulation in the treatment of intractable trigeminal neuralgia.
作者信息
Xu Shu-jun, Zhang Wen-hua, Chen Teng, Wu Cheng-yuan, Zhou Mao-de
机构信息
Department of Neurosurgery, Qilu Hospital, Shandong University, Ji'nan 250012, China.
出版信息
Chin Med J (Engl). 2006 Sep 20;119(18):1528-35.
BACKGROUND
Percutaneous radiofrequency thermocoagulation of the trigeminal ganglion (PRTTG) is regarded as the first choice for most patients with trigeminal neuralgia (TN) because of its safety and feasibility. However, neuronavigator-guided PRTTG has been seldom reported. The purpose of this study was to assess the safety and efficacy of neuronavigator-guided PRTTG for the treatment of intractable TN.
METHODS
Between January 2000 and December 2004, 54 patients with intractable TN were enrolled into this study and were randomly divided into two groups. The patients in navigation group (n = 26) underwent PRTTG with frameless neuronavigation, and those in control group (n = 28) received PRTTG without neuronavigation. Three months after the operation, the efficacy, side effects, and complications of the surgery were recorded. The patients in the control group were followed up for 10 to 54 months (mean, 34 +/- 5), and those in the navigation group were followed up for 13 to 58 months (mean, 36 +/- 7). Kaplan-Meier analyses of the pain-free survival curves were used for the censored survival data, and the log-rank test was used to compare survival curves of the two groups.
RESULTS
The immediate complete pain-relief rate of the navigation group was 100%, whereas it was 95% in the control. The proportion of sustained pain-relief rates at 12, 24 and 36 months after the procedure were 85%, 77%, and 62% in the navigation group, and 54%, 40%, and 35% in the control. Recurrences in the control group were more common than that in the navigation group. Annual recurrence rate in the first and second years were 15% and 23% in the navigation group, and 46%, 60% in the control group. No side-effect and complication was noted in the navigation group except minimal facial hypesthesia.
CONCLUSION
Neuronavigator-guided PRTTG is a safe and promising method for treatment of intractable TN with better short- and long-term outcomes and lower complication rate than PRTTG without neuronavigation.
背景
经皮三叉神经节射频热凝术（PRTTG）因其安全性和可行性，被视为大多数三叉神经痛（TN）患者的首选治疗方法。然而，关于神经导航引导下PRTTG的报道很少。本研究的目的是评估神经导航引导下PRTTG治疗顽固性TN的安全性和有效性。
方法
2000年1月至2004年12月，54例顽固性TN患者纳入本研究，并随机分为两组。导航组（n = 26）患者接受无框架神经导航下的PRTTG，对照组（n = 28）患者接受无神经导航的PRTTG。术后3个月，记录手术的疗效、副作用和并发症。对照组患者随访10至54个月（平均34±5个月），导航组患者随访13至58个月（平均36±7个月）。对截尾生存数据采用Kaplan-Meier法分析无痛生存曲线，并采用对数秩检验比较两组的生存曲线。
结果
导航组的即刻完全疼痛缓解率为100%，而对照组为95%。术后12、24和36个月时，导航组持续疼痛缓解率分别为85%、77%和62%，对照组分别为54%、40%和35%。对照组的复发比导航组更常见。导航组第一年和第二年的年复发率分别为15%和23%，对照组分别为46%、60%。除轻微面部感觉减退外，导航组未发现副作用和并发症。
结论
神经导航引导下的PRTTG是一种安全且有前景的治疗顽固性TN的方法，与无神经导航的PRTTG相比，具有更好的短期和长期疗效以及更低的并发症发生率。
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