Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
World Neurosurg. 2022 Dec;168:e369-e375. doi: 10.1016/j.wneu.2022.10.033. Epub 2022 Oct 13.
Percutaneous balloon compression is a safe, effective, and minimally invasive therapeutic method for trigeminal neuralgia. Intraoperatively precise compression after the formation of the pear-shaped balloon is the key to the expected effect. In this study, we assessed the relationship between the structure of Meckel's cavity and the shape and intracapsular pressure of the balloon by preoperative magnetic resonance.
We respectively analyzed 58 patients with typical trigeminal neuralgia who underwent percutaneous balloon compression surgery in our department. Reconstruction of magnetic resonance imaging 3-dimensional fast imaging employing steady-state acquisition thin-layer scanning sequence was also performed before the operation to analyze the sagittal features of Meckel's cavity. The pressure was recorded continuously when a pear-shaped balloon was forming during the operation. Meanwhile, the balloon height/length (h/l) ratio was measured. The relationship between Meckel's cavity shape, balloon shape, and pressure was analyzed by mentioned parameters.
The pain of 57 patients was relieved immediately after the operation, and the effective rate was 98.27% (57 of 58); Recurrence in 2 cases within the median follow-up time (7.5 months). Meckel's cavity classification on magnetic resonance showed that the clubbing type, oval type, and flat type accounted for 31.1% (18 of 58), 58.6% (34 of 58), and 10.3% (6 of 58), respectively. The results demonstrated that the intracapsular pressure was low, while the h/l ratio of Meckel's cavity was relatively high. We also found the corresponding pressure results when the ratio was low. However, no significant difference was found between the balloon h/l ratio and Meckel's cavity h/l ratio.
Intracapsular pressure of balloon is negatively correlated with the h/l ratio of Meckel's cavity. The individually differentiated formation of the pear-shaped balloon has little correlation with the sagittal shape of Meckel's cavity.
经皮球囊压迫术是治疗三叉神经痛的一种安全、有效且微创的治疗方法。术中形成梨形球囊后精确的压迫是达到预期效果的关键。本研究通过术前磁共振评估 Meckel 腔的结构与球囊的形状和囊内压之间的关系。
对本科室 58 例行经皮球囊压迫术的典型三叉神经痛患者进行分析。手术前采用磁共振三维快速稳态采集薄层层扫描序列进行重建，分析 Meckel 腔的矢状特征。术中连续记录梨形球囊形成过程中的压力，并测量球囊的高/长（h/l）比值。通过上述参数分析 Meckel 腔形态、球囊形状与压力之间的关系。
57 例患者术后疼痛立即缓解，有效率为 98.27%（57/58）；中位随访时间（7.5 个月）内复发 2 例。磁共振 Meckel 腔分类显示，棒状型、椭圆形和扁平型分别占 31.1%（18/58）、58.6%（34/58）和 10.3%（6/58）。结果表明，囊内压较低，而 Meckel 腔的 h/l 比值相对较高，当比值较低时也发现了相应的压力结果。但球囊 h/l 比值与 Meckel 腔 h/l 比值之间无显著差异。
球囊内压与 Meckel 腔的 h/l 比值呈负相关。梨形球囊的个体化差异形成与 Meckel 腔的矢状形状关系不大。
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