Liao Chang-Chun, Li Jia-Yan, Wu Kai-Hua, Jian Zhi-Heng, Yi Xin-Feng, Weng Zhi-Jian, Chen Gang
Department of Neurosurgery, Zhuhai People's Hospital (Zhuhai Hospital Affifiliated With Jinan University, China), Zhuhai, China.
Front Surg. 2022 May 9;9:895394. doi: 10.3389/fsurg.2022.895394. eCollection 2022.
We retrospectively assessed the surgical results of PBC with preoperative multimodal image fusion and intraoperative Dyna Computed Tomography (CT) in 24 patients with primary trigeminal neuralgia (PTN) to explore a valuable aid for Percutaneous balloon compression (PBC).
We studied the data of 24 patients with PTN. All patients underwent PBC and were assessed with preoperative multimodal image fusion [computed tomography (CT) and magnetic resonance imaging (MRI)] and intraoperative Dyna CT in the Department of Neurosurgery of Zhuhai People's Hospital between October 2020 and September 2021. Multimodal image fusion-three-dimensional (3D) reconstruction of CT and MRI data-was performed using 3D-Slicer software, and preoperative evaluation was performed according to the results of image fusion. Dyna CT was used to dynamically observe the position and shape of the metallic hollow introducer and Fogarty catheter and balloon during the operation to guide the operation in real time. We performed follow-up assessments each month and summarized the clinical characteristics, surgical effects, and complications in all patients.
Surgery was successful for all patients; the patients reported immediate pain relief. Surgical complications included facial numbness in 24 patients (100%), mild masseter weakness in three (12.5%), herpes zoster in three (12.5%), and balloon rupture in one (4.2%). None of the patients had serious surgical complications. The mean follow-up time was 9.6 ± 2.7 months. During the follow-up period, 22 patients (91.7%) experienced no recurrence of pain, and two patients (8.3%) experienced recurrence of pain, of which one underwent secondary PBC surgery.
Preoperative multimodal image reconstruction can help fully evaluate PBC surgery, clarify the etiology, and predict the volume of contrast medium required during the operation. It provided important assistance for PBC treatment of trigeminal neuralgia patients when preoperative multimodal image fusion is combined with intraoperative Dyna CT.
我们回顾性评估了24例原发性三叉神经痛（PTN）患者采用术前多模态图像融合和术中动态计算机断层扫描（CT）进行经皮球囊压迫术（PBC）的手术结果，以探索一种对PBC有价值的辅助手段。
我们研究了24例PTN患者的数据。2020年10月至2021年9月期间，所有患者均在珠海市人民医院神经外科接受了PBC，并进行了术前多模态图像融合[计算机断层扫描（CT）和磁共振成像（MRI）]及术中动态CT检查。使用3D-Slicer软件进行多模态图像融合——CT和MRI数据的三维（3D）重建，并根据图像融合结果进行术前评估。术中使用动态CT实时观察金属空心导引器、Fogarty导管和球囊的位置及形态，以指导手术操作。我们每月进行随访评估，并总结所有患者的临床特征、手术效果及并发症。
所有患者手术均成功；患者术后疼痛立即缓解。手术并发症包括24例（100%）面部麻木、3例（12.5%）咬肌轻度无力、3例（12.5%）带状疱疹和1例（4.2%）球囊破裂。所有患者均无严重手术并发症。平均随访时间为9.6±2.7个月。随访期间，22例（91.7%）患者疼痛未复发，2例（8.3%）患者疼痛复发，其中1例接受了二次PBC手术。
术前多模态图像重建有助于全面评估PBC手术，明确病因，并预测术中所需造影剂的用量。术前多模态图像融合与术中动态CT相结合，为三叉神经痛患者的PBC治疗提供了重要帮助。
