Assaf Alexandre T, Klatt Jan C, Blessmann Marco, Kohlmeier Carsten, Friedrich Reinhard E, Pohlenz Philipp, May Arne, Heiland Max, Jürgens Tim P
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
J Craniomaxillofac Surg. 2015 Apr;43(3):408-13. doi: 10.1016/j.jcms.2014.12.017. Epub 2015 Jan 7.
The objective of this study was to determine whether postoperative control of the neurostimulator placement within the pterygopalatine fossa (PPF) by means of 3-dimensional (3D) cone beam computed tomography (CBCT) was of therapeutic relevance compared to intraoperative CBCT imaging alone.
Immediately after implantation of the sphenopalatine ganglion (SPG) neurostimulator, intraoperative CBCT datasets were generated in order to visualize the position of the probe within the PPF. Postoperatively, all patients received a CBCT for comparison with intraoperatively acquired radiographs.
Twenty-four patients with cluster headache (CH) received an SPG neurostimulator. In 4 patients, postoperative CBCT images detected misplacement not found in intraoperative CBCT. In 3 cases, electrode tips were misplaced into the maxillary sinus and in 1 case into the apex of the PPF superior to the suspected location of the SPG. Immediate revision with successful repositioning within 3 days was done in 2 patients and a deferred reimplantation in 1 patient within 6 months. One patient declined revision.
We were able to demonstrate the clinical value of postoperative dental CBCT imaging with a wide region of interest (ROI) due to a superior image quality compared with that achieved with intraoperative medical CBCT. Although intraoperative 3D CBCT imaging of electrode placement is helpful in the acute surgical setting, resolution is, at present, too low to safely exclude misplacement, especially in the maxillary sinus. High-resolution postoperative dental CBCT allows rapid detection and revision of electrode misplacement, thereby avoiding readmission and recurrent tissue trauma.
本研究的目的是确定与仅使用术中锥形束计算机断层扫描（CBCT）成像相比，通过三维（3D）锥形束计算机断层扫描（CBCT）对翼腭窝（PPF）内神经刺激器放置进行术后控制是否具有治疗相关性。
蝶腭神经节（SPG）神经刺激器植入后立即生成术中CBCT数据集，以可视化PPF内探头的位置。术后，所有患者均接受CBCT检查，以便与术中获得的X线片进行比较。
24例丛集性头痛（CH）患者接受了SPG神经刺激器。4例患者的术后CBCT图像检测到术中CBCT未发现的位置错误。3例电极尖端误置入上颌窦，1例误置入PPF尖部，高于SPG的疑似位置。2例患者在3天内立即进行了翻修并成功重新定位，1例患者在6个月内延期重新植入。1例患者拒绝翻修。
我们能够证明术后牙科CBCT成像在临床中的价值，由于其图像质量优于术中医用CBCT，具有广泛的感兴趣区域（ROI）。尽管电极放置术中的3D CBCT成像在急性手术环境中很有帮助，但目前分辨率过低，无法安全排除位置错误，尤其是在上颌窦中。高分辨率术后牙科CBCT可快速检测和修正电极位置错误，从而避免再次入院和反复的组织创伤。
