DZY-B型三叉神经立体定向仪治疗三叉神经痛的临床应用研究(附135例疗效分析)

目的对135例三叉神经痛随机分为两组,定向组和徒手组,比较两组的穿刺成功率和解痛疗效.方法定向组将定向仪固定在病人头上,摄X线的颅底及侧位片,测算卵圆孔的三维坐标值,在立体定向仪的导引下,穿刺针通过卵圆孔进入三叉神经池,缓慢注入99.5%甘油(0.2～0.4m1).徒手组则用Hartel法进行穿刺,然后进行甘油注射治疗.结果定向组的穿刺成功率为100%,徒手组为88.7%.定向组的完全解痛率为98%,部分解痛率为2%,总的疗效为100%;而徒手组则为30(85.7%),1(2.85%),88.55%(P＜0.01),差异有非常显著的意义.结论应用立体定向仪穿刺法的优点是穿刺准确、成功率高、解痛疗效好,手术并发症少,安全性和疗效均比徒手穿刺好.     

DZY-C型三叉神经立体定向仪的临床应用

目的 总结应用DZY-C型三叉神经立体定向仪对120例三叉神经痛患者的治疗，寻求治疗三叉神经痛的良好方法。方法 将病人头部同定在定向仪上，用普通X线机摄取颅底片及侧位片，测算卵例孔的位置，在定向仪的引导下穿刺针经卵圆孔进入三叉神经半月节及三叉神经节池，注射甘油治疗原发性三叉神经痛。结果 穿刺治疗120例三叉神经痛患者，一次性穿刺的成功率高达99．17％。结论 应用立体定向仪定向穿刺，可将凭借经验性的不确定的穿刺变为标准化的穿刺，较徒手穿刺更具科学性。     

简易三叉神经定向仪（DC—Ⅲ型）的临床应用

目的：为了治疗三叉神经痛，获得好的解痛疗效，减少术中疼痛，术后并发症和夏发率。我们研制成ＤＣ－Ⅲ型简易三叉神经定向仪供临床应用。方法；自１９９２年６月至１９９６年１２月，采用立体定向此导下经皮半月神经后根甘油注射治疗三叉神经痛２００例，从颅底Ｘ线摄片上测算卵圆孔的立体坐标数值，将定向仪固定在双侧颧弓上，在立体定向导引下，可顺利地把针经卵圆孔穿入三叉神经池，缓慢注射９９．５％甘油。结果：术后一个月内     

DZY—C型三叉神经立体定向仪在治疗三叉神经痛中的临床研究

目的 为了治疗三叉神经痛，使穿刺卵圆孔更加快捷与准确，获得好的解痛疗效，减少术中疼痛，术后并发症和复发率，研制成一种新的三叉神经立体定向仪(DZY—C型)供临床应用。方法 首先将病人头部固定在定向仪上，用普通X—线机摄取颅底片及侧位片，测算卵圆孔的位置，在定向仪的引导下穿刺针经卵圆孔进入三叉神经半月节及三叉神经节池。然后选择不同治疗方法，如射频热凝法、甘油注射或酒精注射法治疗原发性三叉神经痛。结果 实验研究及临床应用证明，该定向仪精度高，穿刺卵圆孔靶点的误差小于0．3mm。一次性穿刺的成功率高达100％。结论 三叉神经立体定向仪(DZY—C型)的结构设计合理，精密度高，达到临床应用的要求。手术操作简易，调节灵活，组织损伤少，使用安全。     

简易三叉神经定向仪(DC-Ⅲ型)的临床应用

目的：为了治疗三叉神经痛，获得好的解痛疗效，减少术中疼痛、术后并发症和复发率。我们研制成ＤＣ－Ⅲ型简易三叉神经定向仪供临床应用。方法：自１９９２年６月至１９９６年１２月，采用立体定向引导下经皮半月神经节后根甘油注射治疗三叉神经痛２００例。从颅底Ｘ线摄片上测算卵圆孔的立体坐标数值，将定向仪固定在双侧颧弓上。在立体定向导引下，可顺利地把针经卵圆孔穿入三叉神经池，缓慢注射９９．５％甘油（０．２～０．４ｍｌ）。结果：术后一个月内的近期解痛率９８％；随访１７０例，期限６～３６个月，平均２５个月，远期解痛率９１．７％，无严重并发症及死亡。结论：此手术的主要优点是：解痛效果佳，无严重感觉缺失及眼角膜的并发症。手术技术简易，可获较好的疗效     

DZY-C型三叉神经立体定向仪在治疗三叉神经痛中的临床研究

目的 为了治疗三叉神经痛,使穿刺卵圆孔更加快捷与准确,获得好的解痛疗效,减少术中疼痛,术后并发症和复发率,研制成一种新的三叉神经立体定向仪(DZY-C型)供临床应用。方法 首先将病人头部固定在定向仪上,用普通X-线机摄取颅底片及侧位片,测算卵圆孔的位置,在定向仪的引导下穿刺针经卵圆孔进入三叉神经半月节及三叉神经节池。然后选择不同治疗方法,如射频热凝法、甘油注射或酒精注射法治疗原发性三叉神经痛。结果 实验研究及临床应用证明,该定向仪精度高,穿刺卵圆孔靶点的误差小于0.3mm。一次性穿刺的成功率高达100％。结论 三叉神经立体定向仪(DZY-C型)的结构设计合理,精密度高,达到临床应用的要求。手术操作简易,调节灵活,组织损伤少,使用安全。     

应用立体定向仪与徒手穿刺治疗三叉神经痛的比较

目的比较应用三叉神经立体定向仪与徒手穿刺三叉神经半月节治疗原发性三叉神经痛的疗效。方法随机将250例原发性三叉神经痛患者,分为应用DZY-C型三叉神经立体定向仪穿刺组(定向组)及应用Hartel法徒手穿刺组(徒手组)进行治疗。结果定向组穿刺成功率、穿刺失败率均明显优于徒手组(P<0.01);而复发率与徒手组比较有降低的趋势(P=0.0986)。结论应用立体定向仪(DZY-C)治疗原发性三叉神经痛的疗效及安全性较徒手穿刺好。     

DZY-C型三叉神经立体定向仪的临床应用

我们在2000年1月至2003年6月期间治疗原发性三叉神经痛患者200例，按就诊顺序随机分为应用三叉神经立体定向仪行三叉神经半月节穿刺定向组(简称定向组)120例和经皮徒手三叉神经半月节穿刺徒手组(简称徒手组)80例，定向组应用自行研制的DZY-c型三叉神经立体定向仪治疗，取得了良好疗效，报道如下。     

经皮穿刺三叉神经半月节射频热凝+甘油注射治疗原发性三叉神经痛(附85例报告)

目的 探讨采用经皮三叉神经半月节射频热凝 甘油注射治疗原发性三叉神经痛的临床结果和副作用。方法 仰卧位或坐位，Hartel前入路穿刺法，局麻下经卵圆孔穿刺三叉神经半月节，温控射频热凝对靶点进行毁损并注入甘油0．3～0．55ml。结果 疼痛消失82例，无效3例，总有效率96．5％。随访75例，随访时间平均为2．1年，8例复发，复发率为10．6％。结论 经皮三叉神经半月节射频热凝 甘油注射治疗原发性三叉神经痛，可提高治疗效果、降低复发率和副作用，它是高龄或不能耐受开颅手术病人的较好的治疗方法。     

立体定向辅助定位卵圆孔球囊压迫术治疗三叉神经痛

目的总结脑立体定向CT定位卵圆孔在半月神经节球囊压迫术治疗三叉神经痛中的临床效果。方法对20例原发性三叉神经痛患者采用反戴立体定向仪CT定位下行球囊压迫半月神经节。结果 18例患者术后疼痛完全缓解,有效率90%,无严重手术并发症发生。结论 CT立体定向技术为定位穿刺靶点提供了客观依据,避免了穿刺的盲目性,提高了穿刺的准确性和治疗效果,明显降低了并发症。     

Diagnostic accuracy of trigeminal reflex testing in trigeminal neuralgia

The authors prospectively studied 120 consecutive patients with trigeminal neuralgia (TN) to identify the clinical and laboratory features that most accurately distinguished symptomatic from classic TN. After a standardized evaluation, they identified 24 patients with symptomatic TN. Age, sensory examination, and affected division were not useful in the differential diagnosis. In contrast, electrophysiologic testing of trigeminal reflexes accurately distinguished symptomatic from classic TN (sensitivity 96%, specificity 93%).     

Neurophysiologic assessment of trigeminal function after surgery for trigeminal neuralgia

To assess the function of the three trigeminal divisions, we studied corneal reflex, early and late blink reflexes, early and late masseter silent periods, and jaw jerk in normal subjects and in 35 patients submitted to surgery for trigeminal neuralgia. The corneal reflex was most sensitive to thermocoagulation and the jaw jerk to microcompression; the other reflexes showed an intermediate behavior, depending on afferent fiber size. Trigeminal function was less impaired after microcompression and recovered earlier than after thermocoagulation.     

Facial trigeminal synkinesis associated with a trigeminal schwannoma.

The authors describe the clinical and electrophysiologic findings in a patient with synkinesis between muscles innervated by the facial and trigeminal nerves after resection of a trigeminal schwannoma. Conventional facial nerve conduction and blink reflex studies were normal. Stimulation of the supraorbital and facial nerves elicited reproducible responses in the masseter and pterygoid muscles, confirming a peripheral site of aberrant regeneration of the facial and trigeminal nerves.     

Treatment of trigeminal neuralgia by glycerol gangliolysis of the trigeminal ganglion

Sixteen cases are reported treated with glycerol gangliolysis of Gasser's ganglion for trigeminal neuralgia. Glycerol was injected into Meckel's cavum from the percutaneous approach of H?rtel with radiological monitoring. In the follow-up from 6 months to 2 years in 75% of cases no recurrence of neuralgia was observed. No complications were noted. The method seems to be particularly indicated in elderly patients and those with concomitant internal diseases in whom a decompressing operation in the area of the cerebellopontine angle is connected with greater risk.     

Osteopontin-immunoreactivity in the rat trigeminal ganglion and trigeminal sensory nuclei

Osteopontin-immunoreactivity (OPN-ir) was examined in the oro-facial tissues and trigeminal sensory nuclei (principal sensory nucleus and spinal trigeminal nucleus) to ascertain the peripheral ending and central projection of OPN-containing primary sensory neurons in the trigeminal ganglion (TG). No staining was observed using mouse monoclonal anti-OPN antibody preabsorbed with recombinant mature OPN. OPN-immunoreactive (ir) peripheral endings were classified into two types: encapsulated and unencapsulated types. Unencapsulated endings were subdivided into two types: simple and complex types. Simple endings were characterized by the thin neurite that was usually devoid of ramification. These endings were seen in the hard plate and gingiva. The complex type was characterized by the thick ramified neurite, and observed in the vibrissa, hard palate, and molar periodontal ligament. Encapsulated endings were found only in the hard palate. The trigeminal sensory nuclei contained OPN-ir cell bodies and neuropil. The neuropil was devoid of ir in laminae I and II of the medullary dorsal horn (MDH), and had various staining intensities in other regions of the trigeminal sensory nuclei. Transection of the infraorbital and inferior alveolar nerves caused an increase of OPN-ir intensity in ipsilateral TG neurons. The staining intensity of the neuropil also increased in the trigeminal sensory nuclei ipsilateral to the neurotomy excepting laminae I and II of the MDH. The present study indicates that OPN-ir primary sensory neurons in the TG innervate encapsulated and unencapsulated corpuscular endings. Such neurons probably project their central terminals to the trigeminal sensory nuclei except for the superficial laminae of the MDH.     

Pathogenesis of trigeminal neuralgia

<正>To the editor,I read with interest the article,"Differences in individual susceptibility affect the development of trigeminal neuralgia"by Duransoy et al.(2013).The authors have analyzed the possible pathogenesis of trigeminal neuralgia,with illustrative case examples.They have drawn very important conclusions,which may have implications in