Tang Yuan-Zhang, Jin Di, Bian Jing-Jing, Li Xuan-Ying, Lai Guang-Hui, Ni Jia-Xiang
From the *Department of Pain Management, Xuanwu Hospital of Capital Medical University, Beijing; and †Department of anesthesiology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China.
J Craniofac Surg. 2014 Jul;25(4):1292-5. doi: 10.1097/SCS.0000000000000591.
The incidence of trigeminal neuralgia (TN) in elderly patients is higher. However, for those with poor fitness, the optimal surgical treatment for those refractory to medical treatment is controversial. The aim of current study was to investigate the long-term outcome of computed tomography (CT)-guided percutaneous radiofrequency thermocoagulation (PRT) for 304 TN patients 70 years or older. We conducted a retrospective study of 304 elderly patients with TN who were treated with CT-guided PRT between 2002 and 2012. Follow-up was censored at the time of last contact, additional surgery, or death. Sixty-seven patients (22.1%) were of more than American Society of Anesthesiologists classification system physical status II. Excellent pain relief was 100% at discharge, 85% at 1 year, 75% at 3 years, 71% at 5 years, and 49% at 10 years. Pain relief outcomes were correlated with facial numbness. Lower temperature group (≤75°C) can attain the same long-term pain relief as higher temperature group (≥80°C); however, the incidence of painful dysesthesia rate of higher temperature group was higher than lower temperature group. Postoperative morbidity included facial numbness, masseter weakness, corneitis, hearing loss, dropping eyelid, and limited mouth opening. There were no mortalities observed during or after PRT. Our result showed CT-guided PRT is safe and effective for classic TN patients 70 years or older, including poor-fitness patients (American Society of Anesthesiologists classification system physical status >II). Lower temperature (≤75°C) is recommended for PRT in the treatment of TN.
老年患者三叉神经痛（TN）的发病率较高。然而，对于身体状况较差的患者，药物治疗无效时的最佳手术治疗方法存在争议。本研究的目的是调查计算机断层扫描（CT）引导下经皮射频热凝术（PRT）治疗304例70岁及以上TN患者的长期疗效。我们对2002年至2012年间接受CT引导下PRT治疗的304例老年TN患者进行了回顾性研究。随访在最后一次接触、再次手术或死亡时结束。67例患者（22.1%）美国麻醉医师协会身体状况分级系统超过II级。出院时疼痛完全缓解率为100%，1年时为85%，3年时为75%，5年时为71%，10年时为49%。疼痛缓解结果与面部麻木相关。低温组（≤75°C）与高温组（≥80°C）可获得相同的长期疼痛缓解效果；然而，高温组疼痛性感觉异常的发生率高于低温组。术后并发症包括面部麻木、咬肌无力、角膜炎、听力丧失、眼睑下垂和张口受限。PRT期间及术后均未观察到死亡病例。我们的结果表明，CT引导下PRT对70岁及以上的典型TN患者是安全有效的，包括身体状况较差的患者（美国麻醉医师协会身体状况分级系统>II级）。治疗TN时，PRT建议采用较低温度（≤75°C）。
