Zhao Yan-Xing, Miao Su-Hua, Tang Yuan-Zhang, He Liang-Liang, Yang Li-Qiang, Ma Yu, Ni Jia-Xiang
Department of Pain Management, Xuanwu Hospital of Capital Medical University Department of Neurosurgery, Yuquan Hospital, Tsinghua University, Beijing, China.
Medicine (Baltimore). 2017 Jan;96(3):e5872. doi: 10.1097/MD.0000000000005872.
To reflect the extent of thermolesion of ganglion by testing the change of trigeminal somatosensory-evoked potential (TSEP) before and after ganglion radiofrequency thermocoagulation surgery (GRT), and evaluate long-term clinic effect by follow-up visiting of 1 year.Patients with idiopathic trigeminal neuralgia (TN) in the second division were enrolled between October 2014 and October 2015. They were treated with computed tomography-guided GRT and a follow-up visiting of 1 year. Bilateral TSEP measurements were performed 1 day before and 2 days after the GRT surgery. The latency and peak-to-peak amplitude of W2 and W3 were recorded.Immediate postprocedure pain relief (grades I-III) was 100% and 92.5% 1 year later. Facial numbness rate of grades III and IV was 70%, 40%, and 12.5%, respectively, at immediate, 2 days, and 1 year after GRT. No sever complications happened. The latency of W2 and W3 of patients who had no pain no numbness after 1 year of GRT was 1.74 ± 0.24 and 3.84 ± 0.66 ms, respectively, of TN side, and 1.71 ± 0.39 and 3.63 ± 0.85 ms of the healthy side before GRT. The amplitude of W2 and W3 was 1.13 ± 0.50 and 1.99 ± 1.09 uv, respectively, of TN side and 1.24 ± 0.40 and 1.89 ± 0.81 uv of the healthy side before GRT. There was no statistical difference of the latency and amplitude between 2 sides of W2 and W3 before surgery (P > 0.05). The latency of W2 and W3 delayed and the amplitude reduced especially in TN side after surgery comparing before (P < 0.001). And, comparisons of the latency and amplitude of W2 and W3 between TN side and the healthy side after surgery showed the latency of W2 and W3 delayed (W2: P = 0.02; W3: P = 0.01) and the amplitude of W2 reduced (P = 0.003), but the amplitude of W3 had no statistical difference (P = 0.22). The mean delayed latency and 95% confident interval of W2 and W3 were 0.22 ± 0.35 (0.1-0.34) ms and 0.35 ± 0.64 (0.14-0.57) ms, respectively. The mean decreased amplitude and 95% confident interval of W2 and W3 were 22 ± 24 (14-30)% and 23 ± 32 (12-34)%, respectively.GRT can make the latency delay and the amplitude decrease of TSEP. And the latency and amplitude of W2 and W3 can be considered reliable and safe reference for monitoring the extent of thermolesion.
通过检测三叉神经节射频热凝术（GRT）前后三叉神经体感诱发电位（TSEP）的变化，反映神经节热损伤程度，并通过1年的随访评估长期临床效果。选取2014年10月至2015年10月间诊断为第二支特发性三叉神经痛（TN）的患者，行CT引导下GRT并随访1年。分别于GRT手术前1天及术后2天进行双侧TSEP检测，记录W2和W3的潜伏期及峰峰值。术后即刻疼痛缓解（Ⅰ - Ⅲ级）率为100%，1年后为92.5%。GRT术后即刻、术后2天及1年时面部麻木（Ⅲ、Ⅳ级）发生率分别为70%、40%和12.5%。无严重并发症发生。GRT术后1年无痛无麻木患者TN侧W2和W3潜伏期分别为1.74±0.24和3.84±0.66 ms，术前健侧分别为1.71±0.39和3.63±0.85 ms；TN侧W2和W3波幅分别为1.13±0.50和1.99±1.09 μV，术前健侧分别为1.24±0.40和1.89±0.81 μV。术前W2和W3两侧潜伏期及波幅比较差异无统计学意义（P＞0.05）；术后与术前比较，W2和W3潜伏期延长、波幅降低，尤其在TN侧（P＜0.001）。术后TN侧与健侧W2和W3潜伏期及波幅比较，W2和W3潜伏期延长（W2：P = 0.02；W3：P = 0.01），W2波幅降低（P = 0.003），W3波幅差异无统计学意义（P = 0.22）。W2和W3平均潜伏期延迟及95%可信区间分别为0.22±0.35（0.1 - 0.34）ms和0.35±0.64（0.14 - 0.57）ms；W2和W3平均波幅降低及95%可信区间分别为22±24（14 - 30）%和23±32（12 - 34）%。GRT可使TSEP潜伏期延长、波幅降低，W2和W3的潜伏期及波幅可作为监测热损伤程度的可靠、安全指标。
