射频热凝脊神经根切断术治疗微血管减压术后复发性三叉神经痛。

Radiofrequency thermocoagulation rhizotomy for recurrent trigeminal neuralgia after microvascular decompression.

机构信息

Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, China.

出版信息

Chin Med J (Engl). 2011 Nov;124(22):3726-30.

Abstract

BACKGROUND

Microvascular decompression (MVD) is a well accepted surgical treatment strategy for trigeminal neuralgia (TN) with satisfying long-term outcome. However, considerable recurrent patients need more effective management. The purpose of this study was to evaluate the effectiveness of radiofrequency thermocoagulation rhizotomy (RTR) on patients with recurrent TN after MVD.

METHODS

Totally 62 cases of recurrent TN after MVD undergoing RTR from January 2000 to January 2010 were retrospectively evaluated. Based on surgical procedures undertaken, these 62 cases were classified into two subgroups: group A consisted of 23 cases that underwent traditional RTR by free-hand; group B consisted of 39 cases that underwent RTR under the guidance of virtual reality imaging technique or neuronavigation system. The patients in group A were followed up for 14 to 70 months (mean, 40 ± 4), and those in group B were followed up for 13 to 65 months (mean, 46 ± 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

All patients in both groups A and B attained immediate pain relief after RTR. Both groups attained good pain relief rate within the first two years of follow-up: 92.3%, 84.6% and 82.6%, 69.6% respectively (P > 0.05). After 2 years, the virtual reality or neuronavigation assisted RTR group (group B) demonstrated higher pain relief rates of 82.5%, 76.2% and 68.8% at 3, 4 and 5 years after operation respectively, while those in group A was 57.2%, 49.6%, and 36.4% (P < 0.05). Low levels of minor complications were recorded, while neither mortalities nor significant morbidity was documented.

CONCLUSIONS

RTR was effective in alleviating the pain of TN cases suffering from unsuccessful MVD management. With the help of virtual reality imaging technique or neuronavigation system, the patients could attain better long-term pain relief.

摘要

背景

微血管减压术（MVD）是治疗三叉神经痛（TN）的一种公认的手术治疗策略，具有令人满意的长期疗效。然而，相当多的复发患者需要更有效的治疗。本研究旨在评估射频热凝神经根切断术（RTR）对 MVD 后复发 TN 患者的疗效。

方法

回顾性分析 2000 年 1 月至 2010 年 1 月间 62 例 MVD 后复发的 TN 患者行 RTR 的临床资料。根据手术方式的不同，将这 62 例患者分为两组：A 组 23 例，采用徒手 RTR；B 组 39 例，采用虚拟现实成像技术或神经导航系统引导下 RTR。A 组随访 14 至 70 个月（平均 40 ± 4），B 组随访 13 至 65 个月（平均 46 ± 7）。采用 Kaplan-Meier 分析对删失生存数据进行分析，采用对数秩检验比较两组生存曲线。

结果

两组患者术后均立即缓解疼痛。两组患者在随访的前 2 年内均获得了较好的疼痛缓解率：92.3%，84.6%和 82.6%，69.6%（P > 0.05）。2 年后，虚拟现实或神经导航辅助 RTR 组（B 组）在术后 3、4、5 年的疼痛缓解率分别为 82.5%、76.2%和 68.8%，而 A 组分别为 57.2%、49.6%和 36.4%（P < 0.05）。记录到低水平的轻微并发症，且无死亡或显著发病率。