You Shaohua, Qin Xiaoyan, Zhao Guoli, Feng Zeguo
Department of Pain Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People's Republic of China.
Department of Clinical Laboratory, Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, 100049, People's Republic of China.
J Pain Res. 2024 Jul 5;17:2347-2356. doi: 10.2147/JPR.S449447. eCollection 2024.
Trigeminal neuralgia (TN) is a common form of craniofacial pain, and Radiofrequency thermocoagulation (RFT) has become a commonly utilized treatment modality for TN. However, the complex anatomical configuration of the maxillofacial region and the difficulties inherent in positioning the neck in a hyperextended manner can present challenges for CT-guided punctures.
The objective of this study is to assess the effectiveness and safety of 3D printed tooth-supported template(3D-PTST) guided RFT in patients who have previously undergone unsuccessful CT-guided puncture.
Patients with TN undergoing RFT at the Department of Pain Medicine, PLA General Hospital, from January 2018 to January 2023, were assessed. 3D-PTST guided RFT was employed as an alternative when percutaneous puncture failed. Clinical, demographic, and follow-up data were collected. The duration of the procedure was determined by subtracting the time of anesthesia administration from the time of surgical drape removal. Pain intensity was assessed using the Numerical Rating Scale-11 scale. Treatment effects were evaluated utilizing the Barrow Neurological Institute scale. Incidences of complications related to RFA were documented.
Six TN patients underwent 3D-PTST guided RFT. With tooth-supported template guidance, five patients achieved therapeutic target puncture in one attempt with one CT scan. One patient required two attempts with two CT scans. Operation duration ranged from 18 to 46 mins (mean 30 mins). All completed 3D-PTST-guided RFT without difficulty, significantly improving pain symptoms. Four patients had no pain recurrence at 12, 18, 36 and 37 months follow-up, respectively. Recurrence occurred in two patients (at 1 and 13 months). No serious treatment-related complications were observed.
3D-PTST guided RFT is an effective, repeatable, safe, and minimally invasive treatment method for patients with TN who have failed due to difficulty in puncture.
三叉神经痛（TN）是颅面部疼痛的常见形式，射频热凝术（RFT）已成为治疗TN的常用方法。然而，颌面部区域复杂的解剖结构以及将颈部过度伸展定位的固有困难给CT引导下穿刺带来了挑战。
本研究旨在评估3D打印牙齿支撑模板（3D-PTST）引导下RFT治疗既往CT引导穿刺失败患者的有效性和安全性。
对2018年1月至2023年1月在中国人民解放军总医院疼痛医学科接受RFT治疗的TN患者进行评估。当经皮穿刺失败时，采用3D-PTST引导RFT作为替代方法。收集临床、人口统计学和随访数据。手术时间通过从手术铺巾移除时间中减去麻醉给药时间来确定。使用数字评分量表-11评估疼痛强度。利用巴罗神经学研究所量表评估治疗效果。记录与RFA相关的并发症发生率。
6例TN患者接受了3D-PTST引导下的RFT。在牙齿支撑模板引导下，5例患者通过一次CT扫描一次穿刺成功达到治疗靶点。1例患者需要两次CT扫描进行两次穿刺。手术时间为18至46分钟（平均30分钟）。所有患者均顺利完成3D-PTST引导下的RFT，疼痛症状明显改善。4例患者在12、18、36和37个月的随访中分别无疼痛复发。2例患者复发（分别在1个月和13个月）。未观察到严重的治疗相关并发症。
3D-PTST引导下的RFT是一种有效、可重复、安全且微创的治疗方法，适用于因穿刺困难而失败的TN患者。
