First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, China.
First Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China.
Pain Physician. 2021 Jul;24(4):E425-E432.
Percutaneous radiofrequency ablation (RFA) of the trigeminal Gasserian ganglion via the foramen ovale is still one of the classic treatments for primary trigeminal neuralgia. However, the Gasserian ganglion is deep in the middle cranial fossa. Although it is a structure outside the brain tissue, the puncture needle must enter the encephalic to reach the Gasserian ganglion and so it is difficult to completely avoid the risk of intracranial hemorrhage and infection caused by puncture damage to intracranial blood vessels. It is not clear whether if it is possible for RFA at the extracranial non-gasserian-ganglion site via the exit of the cranial channel (foramen ovale) for patients with V3 trigeminal neuralgia (TN).
Prospective, clinical research study.
Department of Anesthesiology and Pain Medical Center, Jiaxing, China.
One hundred and seven patients with isolated mandibular branch trigeminal neuralgia were included. Radiofrequency thermocoagulation was performed by CT-guided percutaneous puncture through the foramen ovale. The puncture target was the midpoint of the horizontal transverse diameter of the oval foramen. If the tingling sensation in the mandibular nerve innervation area could be detected, the radiofrequency thermocoagulation (90°C, 120 sec) under intravenous anesthesia would be performed. We investigated the inclination angle, puncture angle and depth, puncture operation time, intraoperative complications and short-term and long-term results after operation.
After radiofrequency thermocoagulation, the pain in the mandibular branch dominant area was completely diminished in 104 patients. Two patients were cured after the second radiofrequency treatment. No intracranial hemorrhage not infection complications occurred, except for facial hematoma during operation in 21 cases. After 12-24 months of follow-up, 9 patients had recurrence and were still effective after receiving additional extracranial radiofrequency treatment.
A control group should be established and more clinical data should be collected in future work.
Extracranial non-Gasserian-ganglion RF can achieve satisfactory results and improve the safety of radiofrequency treatment for trigeminal neuralgia.
经卵圆孔穿刺射频热凝三叉神经节（Gasserian 神经节）治疗原发性三叉神经痛仍然是经典治疗方法之一。然而，Gasserian 神经节位于中颅窝深部，虽然是脑外结构，但穿刺针必须进入颅内才能到达 Gasserian 神经节，因此很难完全避免穿刺损伤颅内血管引起的颅内出血和感染风险。对于 V3 型三叉神经痛（TN）患者，经颅道出口（卵圆孔）行颅外非 Gasserian 神经节射频是否可行尚不清楚。
前瞻性临床研究。
中国嘉兴麻醉科和疼痛医学中心。
纳入 107 例单纯下颌支三叉神经痛患者，在 CT 引导下经卵圆孔行射频热凝，穿刺靶点为卵圆孔水平横径中点。如果能检测到下颌神经支配区的刺痛感，则在静脉麻醉下行射频热凝（90°C，120 秒）。我们研究了倾斜角、穿刺角度和深度、穿刺操作时间、术中并发症以及术后短期和长期结果。
射频热凝后，104 例患者下颌支优势区疼痛完全消失，2 例患者行第二次射频治疗后痊愈。除 21 例术中出现面部血肿外，无颅内出血和感染并发症。随访 12-24 个月，9 例复发，再次行颅外射频治疗仍有效。
今后的工作应建立对照组并收集更多的临床资料。
颅外非 Gasserian 神经节射频可以达到满意的效果，提高三叉神经痛射频治疗的安全性。
