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选择性射频热凝治疗三叉神经痛1860例临床研究

Selective percutaneous radiofrequency thermocoagulation for the treatment of trigeminal neuralgia 1860 cases report

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【作者】 吴承远孟凡刚王宏伟刘玉光徐淑军孙召花

【Author】 WU Cheng-yuan MENG Fan-gang WANG Hong-wei, et al. Department of Neurosurgery QiLu Hospital of Shandong University Jinan 250012 China

【机构】 山东大学齐鲁医院神经外科山东大学齐鲁医院神经外科 250012济南250012济南

【摘要】 目的对1860例采用选择性射频热凝治疗的三叉神经痛病例进行分析,并探讨X线、三维CT及导航卵圆孔定位在难治性三叉神经痛射频热凝治疗中的应用及技巧。方法对单纯第I支、第II支和第III支疼痛者分别进行眶上孔、眶下孔或侧入路卵圆孔射频热凝治疗。对第II支合并第III支疼痛者应用改良的Hartel前入路卵圆孔穿刺法进行温控射频热凝靶点毁损。同时对42例定位困难的三叉神经痛病人,在射频热凝治疗术中应用X线、三维CT或导航进行卵圆孔定位或在术中验证靶点。结果术后即刻疗效:优良1465例,良好326例,无疗效69例,总有效率96.3%。8个月~2年远期随访1052例,1年内复发117例,2年内复发261例,1年复发率为11.1%,2年复发率为24.8%,无严重并发症发生。结论温控热凝治疗三叉神经痛疗效可靠,X线、三维CT及导航卵圆孔定位弥补了徒手穿刺的缺陷,提高了卵圆孔穿刺的成功率和精确性,可供临床推广应用。

【Abstract】 Objective Selective percutaneous radiofrequency thermocoagulation were performed on 1860 cases with trigeminal neuralgia. X-ray 3D-CT and navigation oval foramen locations were used in 22 19 and 1 patient respectively on intractable trigeminal neuralgia. Methods Supraorbital foramen infraorbital foramen and oval foramen radiofrequency thermocoagulation were performed on 1860 cases of trigeminal neuralgia. X-ray 3D-CT and navigation oval foramen locations were used in 42 cases intractable location so that the direction and position could be defined for trigeminal neuralgia. Result Pain alleviation immediately but no serious complication occurred in all of the patients. The effective rate is 96.3%. Conclusion Selective percutaneous radiofrequency thermocoagulation is an effective way for the treatment of trigeminal neuralgia. X-ray 3D-CT and navigation oval foramen locations can raise the successful rate of puncture enhance the safety and reduce the incidence rate of complication.

【关键词】 三叉神经痛; 射频热凝术; 卵圆孔;

【Key words】 Trigeminal neuralgia; Radiofrequency therapy; Oval foramen;

【分类号】R745.11;R321.56;R454.12;

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