Ruschel Leonardo Gilmone, Agnoletto Guilherme José, Hunhevicz Sonival Cândido, Almeida Daniel Benzecry de, Arruda Walter Oleschko
MD, Neurosurgery Department, Instituto de Neurologia de Curitiba (INC), Curitiba, PR, Brazil.
Neurosurgeon, Neurosurgery Department, INC, Curitiba, PR, Brazil.
Rev Assoc Med Bras (1992). 2017 Apr;63(4):307-310. doi: 10.1590/1806-9282.63.04.307.
Osteogenesis imperfecta (OI) is a bone disorder that can lead to skull base deformities such as basilar invagination, which can cause compression of cranial nerves, including the trigeminal nerve. Trigeminal neuralgia in such cases remains a challenge, given distorted anatomy and deformities. We present an alternative option, consisting in cannulation of the foramen ovale and classical percutaneous treatment. Percutaneous balloon microcompression was performed in a 28 year-old woman with OI and severe trigeminal neuralgia using computed tomography (CT) and radiographic-guided cannulation of the Gasserian ganglion without neuronavigation or stereotactic devices. The patient developed hypoesthesia on the left V1, V2 and V3 segments with good pain control. This alternative technique with a CT-guided puncture, using angiosuite without the need of any Mayfield clamp, neuronavigation systems, frame or frameless stereotactic devices can be a useful, safe and efficient alternative for patients with trigeminal neuralgia with other bone deforming diseases that severely affect the skull base.
成骨不全症（OI）是一种骨病，可导致颅底畸形，如基底凹陷，进而可引起包括三叉神经在内的颅神经受压。鉴于解剖结构扭曲和畸形，此类病例中的三叉神经痛仍然是一个挑战。我们提出一种替代方案，即卵圆孔插管和经典的经皮治疗。在一名患有成骨不全症和严重三叉神经痛的28岁女性患者中，在无神经导航或立体定向设备的情况下，使用计算机断层扫描（CT）和放射学引导的半月神经节插管进行了经皮球囊微压迫术。患者左侧V1、V2和V3节段出现感觉减退，但疼痛得到了良好控制。这种采用CT引导穿刺、使用血管套件且无需任何梅菲尔德夹、神经导航系统、框架或无框架立体定向设备的替代技术，对于患有严重影响颅底的其他骨变形疾病的三叉神经痛患者而言，可能是一种有用、安全且有效的替代方法。
