Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital, Pilsen, Czech Republic.
Department of Imaging Methods, Faculty of Medicine in Pilsen, Charles University, University Hospital, Pilsen, Czech Republic.
Acta Neurochir (Wien). 2024 Nov 22;166(1):469. doi: 10.1007/s00701-024-06364-9.
Percutaneous rhizotomy of the Gasserian ganglion is a well-established intervention for patients suffering from refractory trigeminal pain, not amenable to pharmacological management or microvascular decompression. Traditionally conducted under fluoroscopic guidance using Hartel's technique, this study investigates a modified approach employing low-dose CT guidance to achieve maximal procedural precision and safety with the emphasis on minimizing radiation exposure.
A retrospective analysis of patients undergoing percutaneous rhizotomy of the Gasserian ganglion at our institution was undertaken. Procedures were divided into fluoroscopy and CT-guided foramen ovale (FO) cannulation cohorts. Radiation doses were assessed, excluding cases with incomplete data. The study included 32 procedures in the fluoroscopy group and 30 in the CT group.
In the CT-guided group, the median effective dose was 0.21 mSv. The median number of CT scans per procedure was 4.5, and the median procedure time was 15 min. Successful FO cannulation was achieved in all 30 procedures (100%). In the fluoroscopy group, the median effective dose was 0.022 mSv, and the median procedure time was 15 min. Cannulation of FO was successful in 31 of 32 procedures (96.9%). The only complications in the CT-guided group were three minor cheek hematomas. Immediate pain relief in the CT-guided group was reported in 25 of 30 procedures (83.3%), 22 of 30 (73.3%) provided relief at one month, and 10 of 18 (55.6%) procedures resulting in pain relief at one month continued to provide relief after two years.
Low-dose CT-guided percutaneous rhizotomy conducted in the radiology suite carries negligible radiation exposure for patients and eliminates it for personnel. This method is fast, simple, precise, and carries a very low risk of complications.
对于无法通过药物管理或微血管减压治疗的难治性三叉神经痛患者，经皮半月神经节射频热凝术是一种成熟的治疗方法。该手术传统上在透视引导下采用 Hartel 技术进行，本研究采用低剂量 CT 引导进行改良，旨在实现最大的程序精度和安全性，重点是尽量减少辐射暴露。
对我院行经皮半月神经节射频热凝术的患者进行回顾性分析。将手术分为透视引导和 CT 引导经卵圆孔（FO）入路两组。评估辐射剂量，但不包括数据不完整的病例。研究包括透视组 32 例和 CT 组 30 例。
在 CT 引导组，中位有效剂量为 0.21 mSv。每例手术的中位 CT 扫描次数为 4.5 次，中位手术时间为 15 分钟。30 例手术均成功进行 FO 穿刺（100%）。在透视组，中位有效剂量为 0.022 mSv，中位手术时间为 15 分钟。FO 穿刺成功率为 31/32（96.9%）。CT 引导组唯一的并发症是 3 例轻微颊部血肿。30 例 CT 引导组中有 25 例（83.3%）立即缓解疼痛，22 例（73.3%）在 1 个月时缓解，18 例（55.6%）中有 10 例在 1 个月时缓解疼痛的患者在 2 年后继续缓解。
在放射科进行的低剂量 CT 引导经皮半月神经节射频热凝术，为患者带来可忽略不计的辐射暴露，同时为医护人员消除了辐射暴露。这种方法快速、简单、精确，且并发症风险极低。
