动态CT辅助经皮微球囊压迫术治疗三叉神经痛
Dyna-CT-assisted percutaneous microballoon compression for trigeminal neuralgia.
作者信息
Huo Xiaochuan, Sun Xiaoyun, Zhang Zhenxing, Guo Wenshi, Guan Ning, Luo Junsheng
机构信息
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China.
Brain and Spinal Cord Injury Laboratory, Department of Neurosurgery, The First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning, P.R. China.
出版信息
J Neurointerv Surg. 2014 Sep;6(7):521-6. doi: 10.1136/neurintsurg-2013-010676. Epub 2013 Jul 31.
BACKGROUND
Percutaneous microballoon compression (PMC) for trigeminal neuralgia (TN) is a well-established technique. However, complications from cannulating the foramen ovale (FO) have been reported because direct puncture of the FO is sometimes difficult. Here we report our experience with Dyna-CT-assisted PMC for TN in cannulating the FO and determining the position and volume of the balloon.
METHODS
Dyna-CT-assisted PMC was performed for image reconstruction in 16 cases. The optimal working projection was generated and further fluoroscopic data were used to determine the relationship of the needle with the FO during puncture. The balloon position and three-dimensional shape were verified with Dyna-CT during balloon compression and the balloon volume and puncture angle were also calculated. Patients' prognosis is discussed.
RESULTS
Dyna-CT allows quick, safe and easy cannulation of the FO. It provided three-dimensional images which were more elaborate than the classic 'pear shape' images for determining correct positioning in 16 cases. The volume of the inflated balloon ranged from 568.2 mm(3) to 891.4 mm(3) (average 769.5 mm(3)). The angle of introducing the cannula ranged from 15.32° to 35.48° rotation to the midline (average 25.18°) and 38.47°-51.89° angulation to the Reid line (average 46.17°). All the patients were pain-free after PMC. Four patients had resolvable masseter weakness and fine touch loss. No recurrence of TN was reported on follow-up.
CONCLUSIONS
Dyna-CT performed by digital subtraction angiography assists PMC in three ways: (1) the FO can be better visualized independent of the patient's position; (2) needle correction or insertion can be performed much more easily because of the direct fluoroscopic control; and (3) the needle position, balloon position, balloon configuration and the volume of the inflated balloon is more reliably determined. The use of Dyna-CT-assisted PMC has a low incidence of complications and a good prognosis.
背景
经皮微球囊压迫术（PMC）治疗三叉神经痛（TN）是一项成熟的技术。然而，有报道称卵圆孔（FO）插管存在并发症，因为直接穿刺FO有时很困难。在此，我们报告在Dyna-CT辅助下进行PMC治疗TN时，在FO插管以及确定球囊位置和体积方面的经验。
方法
对16例患者进行Dyna-CT辅助PMC以进行图像重建。生成最佳工作投影，并在穿刺过程中使用进一步的荧光透视数据来确定针与FO的关系。在球囊压迫期间用Dyna-CT验证球囊位置和三维形状，并计算球囊体积和穿刺角度。讨论患者的预后情况。
结果
Dyna-CT可实现快速、安全且简便的FO插管。它提供的三维图像比经典的“梨形”图像更精细，有助于在16例患者中确定正确定位。膨胀球囊的体积范围为568.2 mm³至891.4 mm³（平均769.5 mm³）。插管引入角度从中线旋转角度为15.32°至35.48°（平均25.18°），与Reid线的成角为38.47°至51.89°（平均46.17°）。所有患者在PMC后均无痛。4例患者出现可缓解的咬肌无力和精细触觉丧失。随访未报告TN复发。
结论
通过数字减影血管造影术进行的Dyna-CT在三个方面辅助PMC：（1）无论患者体位如何，均可更好地显示FO；（2）由于直接的荧光透视控制，针的校正或插入更容易进行；（3）更可靠地确定针的位置、球囊位置、球囊形态以及膨胀球囊的体积。使用Dyna-CT辅助PMC并发症发生率低，预后良好。
Zotero 插件