Intraoperative Neurophysiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Neurosurgery. 2012 Jun;70(2 Suppl Operative):259-63. doi: 10.1227/NEU.0b013e318241801a.
Radiofrequency thermorhizotomy of the trigeminal nerve is a known treatment of trigeminal neuralgia. Analysis of verbal responses to electric stimulation of the trigeminal rootlets has been the only method available to localize the affected branch, but patient discomfort may lead to unreliable verbal responses, resulting in increased morbidity or even therapeutic failure. Orthodromically elicited evoked potentials of the trigeminal nerve have also been used, but their application is tedious and results may vary.
To develop an electrophysiological method for intraoperative localization of the trigeminal nerve branches.
A series of 55 patients under general anesthesia during radiofrequency thermorhizotomy were studied. The trigeminal nerve root was stimulated through the foramen ovale with the RF electrode. Antidromic responses were recorded from the 3 divisions of the trigeminal nerve in the face. Effectiveness rate, pain relief, recurrence, complications, and patient comfort after the procedure were analyzed.
Reproducible and easily obtained antidromic responses were clearly recorded in every subdivision of the trigeminal nerve in all patients. Ninety-four percent of patients experienced immediate pain relief after the procedure. The recurrence rate was 12.72%, and the surgical morbidity was 20%.
This method proved to be useful to determine the exact localization of individual subdivisions of the trigeminal nerve in anesthetized patients, making this procedure safer and more comfortable for them.
射频三叉神经热凝术是治疗三叉神经痛的一种已知方法。分析根丝电刺激的言语反应一直是定位受影响分支的唯一方法，但患者的不适可能导致不可靠的言语反应，从而增加发病率甚至治疗失败。三叉神经根的顺行诱发电位也已被应用，但它们的应用繁琐，结果可能有所不同。
开发一种用于术中定位三叉神经分支的电生理学方法。
对 55 例在射频热凝术中全身麻醉下的患者进行了研究。通过卵圆孔用射频电极刺激三叉神经根。从面部的三叉神经的 3 个分支记录逆行反应。分析手术的有效率、疼痛缓解、复发、并发症和患者术后舒适度。
在所有患者中，每个三叉神经分支都能清晰地记录到可重复且易于获得的逆行反应。94%的患者在手术后立即缓解疼痛。复发率为 12.72%，手术发病率为 20%。
该方法被证明可用于确定麻醉患者三叉神经各个分支的确切定位，使该手术对患者更安全、更舒适。
