Yang Jen-Tsung, Lin Martin, Lee Ming-Hsueh, Weng Hsu-Huei, Liao Han-Hung
Department of Neurosurgery, Chang Gung Memorial Hospital at Chiayi, Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC.
Chang Gung Med J. 2010 Nov-Dec;33(6):679-83.
Percutaneous radiofrequency trigeminal rhizotomy offers high rates of complete pain relief for classic idiopathic trigeminal neuralgia. When performed under fluoroscopy, it may cause anxiety for an inexperienced neurosurgeon owing to lack of familiarity with the regional anatomy, lack of reliable landmarks on fluoroscopy, and perceived risks associated with inadvertent puncture of neurovascular structures near the foramen ovale. The purpose of this study is to describe a new procedure to maximize patient security and shorten operative time.
From January 2006 to May 2009, 79 patients with trigeminal neuralgia underwent computerized tomography (CT)-guided percutaneous radiofrequency trigeminal rhizotomy under local anesthesia at Chang Gung Memorial Hospital. These patients included 22 men and 57 women, whose ages ranged from 36 to 88 years. The authors analyzed the use of CT with three-dimensional image reconstruction for the guidance of rhizotomy needle placement to determine possible difficulties during surgery and to predict the outcome of surgery.
The surgical outcome of CT-guided trigeminal rhizotomy was good in 63 (80%, 95% confidence interval [CI] 69.2-88.0%) of the 79 patients with more than 90% (95% CI 87.5-93.7%) pain relief. The outcomes did not differ from those of the fluoroscopy-guided procedures. However, the median time for adequate rhizotomy needle placement in the foramen ovale was reduced in the CT-guided compared with that in fluoroscopy-guided procedure (14 minutes and 40 minutes, respectively; p < 0.001) and the intra-operative discomfort of the patients was also decreased. There were no intra-operative failures.
For percutaneous trigeminal rhizotomy, three-dimensional image reconstruction provides for precise placement of the rhizotomy needle in a safe and timely manner, which improves patient comfort and shortens operative time.
经皮射频三叉神经切断术可使典型特发性三叉神经痛患者获得较高的完全疼痛缓解率。在荧光镜引导下进行该手术时，由于缺乏对局部解剖结构的熟悉、荧光镜下缺乏可靠的标志以及对卵圆孔附近神经血管结构意外穿刺相关风险的认知，可能会使经验不足的神经外科医生感到焦虑。本研究的目的是描述一种新的手术方法，以最大限度地保障患者安全并缩短手术时间。
2006年1月至2009年5月，79例三叉神经痛患者在长庚纪念医院接受了局部麻醉下的计算机断层扫描（CT）引导经皮射频三叉神经切断术。这些患者包括22名男性和57名女性，年龄在36至88岁之间。作者分析了使用带有三维图像重建的CT来指导切断术针的放置，以确定手术中可能出现的困难并预测手术结果。
79例患者中，63例（80%，95%置信区间[CI] 69.2 - 88.0%）CT引导下三叉神经切断术的手术效果良好，疼痛缓解率超过90%（95% CI 87.5 - 93.7%）。其结果与荧光镜引导手术的结果无差异。然而，与荧光镜引导手术相比，CT引导下将切断术针正确放置在卵圆孔的中位时间缩短（分别为14分钟和40分钟；p < 0.001），患者术中不适也有所减轻。术中无失败病例。
对于经皮三叉神经切断术，三维图像重建能够安全、及时地精确放置切断术针，提高了患者舒适度并缩短了手术时间。
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