Department of Pain Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China.
Department of Pain Medicine, Jinan Zhangqiu District Hospital of Traditional Chinese Medicine, Jinan, People's Republic of China.
Medicine (Baltimore). 2024 Apr 19;103(16):e37884. doi: 10.1097/MD.0000000000037884.
Trigeminal herpes zoster, which comprises 10% to 20% of cases of herpes zoster, often leads to severe pain in the ophthalmic branches. Current treatments, including drug therapy and minimally invasive interventions, have limitations; accordingly, there is a need to explore alternative approaches. This study aimed to evaluate the efficacy and safety of computerized tomography (CT)-guided pulsed radiofrequency of the sphenopalatine ganglion in patients with intractable trigeminal herpetic pain.
Three patients with intractable trigeminal ophthalmic zoster neuralgia were studied. All patients complained of bursts of headache, which occurred at least 10 times a day, usually in the periorbital and frontal regions. Conventional treatments, including oral medications and radiofrequency therapy targeting the trigeminal-semilunar ganglion and supraorbital nerve, could not sufficiently provide relief.
Two patients were diagnosed with herpes zoster in the ocular branch of the trigeminal nerve with conjunctivitis, while one patient was diagnosed with postherpetic neuralgia in the ocular branch of the trigeminal nerve.
This study employed a novel approach that involved CT-guided radiofrequency regulation of the pterygopalatine fossa sphenopalatine ganglion.
In all three patients, pain relief was achieved within 1 to 3 days after treatment. During the follow-up, one patient had pain recurrence; however, its severity was ≈ 40% lower than the pretreatment pain severity. The second patient had sustained and effective pain relief. However, the pain of the third patient worsened again after 2 months. The average follow-up duration was 3 months. None of the enrolled patients showed treatment-related adverse reactions or complications.
Our findings indicated that CT-guided radiofrequency regulation of the pterygopalatine fossa sphenopalatine ganglion was a safe and effective intervention for pain in patients with trigeminal ophthalmic zoster neuralgia, suggesting that it may be a therapeutic option if other treatments fail.
三叉神经带状疱疹占带状疱疹的 10%~20%，常导致眼支剧烈疼痛。目前的治疗方法，包括药物治疗和微创介入治疗，都存在局限性；因此，需要探索替代方法。本研究旨在评估计算机断层扫描（CT）引导下蝶腭神经节脉冲射频治疗难治性三叉神经疱疹性疼痛的疗效和安全性。
研究了 3 例难治性三叉神经眼支带状疱疹神经痛患者。所有患者均主诉头痛发作，每天至少发作 10 次，疼痛通常位于眼眶和额部。常规治疗，包括口服药物和针对三叉半月神经节和眶上神经的射频治疗，均不能充分缓解疼痛。
2 例患者被诊断为三叉神经眼支带状疱疹合并结膜炎，1 例患者被诊断为三叉神经眼支带状疱疹后神经痛。
本研究采用了一种新方法，即 CT 引导下经翼腭窝蝶腭神经节射频调节。
所有 3 例患者在治疗后 1~3 天内疼痛缓解。在随访期间，1 例患者出现疼痛复发，但疼痛严重程度比治疗前降低了约 40%。第 2 例患者疼痛持续且有效缓解。然而，第 3 例患者的疼痛在 2 个月后再次加重。平均随访时间为 3 个月。所有入组患者均未出现与治疗相关的不良反应或并发症。
我们的研究结果表明，CT 引导下经翼腭窝蝶腭神经节射频调节对三叉神经眼支带状疱疹神经痛患者是一种安全有效的治疗方法，如果其他治疗方法失败，可能是一种治疗选择。
