型三叉神经立体定向仪治疗三叉神经痛的特点(英文)

背景:经皮三叉神经半月穿刺损毁术是治疗原发性三叉神经痛的方法之一。因其穿刺技术操作上的难度,可导致误伤及一些严重的并发症。DZY-C型三叉神经立体定向仪治疗原发性三叉神经痛具有穿刺准确度高、并发症低等特点,可减少误伤周围血管、神经的机会。目的:评价应用DZY-C型三叉神经立体定向仪治疗三叉神经痛的疗效。设计:以患者为研究对象,前后对照研究。单位:一所市级中医院的脑外科和一所市级医院。对象:2001/2003佛山市中医院门诊或住院部就诊的原发性三叉神经痛患者90例,男39例,女51例;年龄21～90岁。干预:所有患者按要求在DZY-C型三叉神经立体定向仪的引导下,经皮穿刺三叉神经半月节,注射甘油。疗效根据视觉模拟评分法(visualana-loguescale,VAS)在患者治疗前及治疗后30min对疼痛程度进行评估。主要观察指标:疗效评定结果。结果:应用DZY-C型三叉神经立体定向仪,对90例原发性三叉神经痛患者进行三叉神经半月节穿刺,均一次穿刺成功,注射甘油后,原三叉神经疼痛消除90例,优良率达100%。结论:DZY-C型三叉神经立体定向仪的结构设计合理,手术操作简易,调节灵活,组织损伤少,使用安全,可明显消除三叉神经痛。     

DZY-C型三叉神经立体定向仪治疗三叉神经痛的特点

背景：经皮三叉神经半月穿刺损毁术是治疗原发性三叉神经痛的方法之一。因其穿刺技术操作上的难度，可导致误伤及一些严重的并发症.DZY—C型三叉神经立体定向仪治疗原发性三叉神经痛具有穿刺准确度高、并发症低等特点，可减少误伤周围血管、神经的机会。目的：评价应用DZY—C型三叉神经立体定向仪治疗三叉神经痛的疗效.设计：以患者为研究对象，前后对照研究。单位：一所市级中医院的脑外科和一所市级医院．对象：2001／2003佛山市中医院门诊或住院部就诊的原发性三叉神经痛患者90例，男39例，女51例；年龄21-90岁。干预：所有患者按要求在DZY—C型三叉神经立体定向仪的引导下，经皮穿刺三叉神经半月节，注射甘油。疗效根据视觉模拟评分法(visual analoguescale，VAS)在患者治疗前及治疗后30min对疼痛程度进行评估。主要观察指标：疗效评定结果。结果：应用DZY—C型三叉神经立体定向仪，对90例原发性三叉神经痛患者进行三叉神经半月节穿刺，均一次穿刺成功，注射甘油后，原三叉神经疼痛消除90例，优良率达100％。结论：DZY—C型三叉神经立体定向仪的结构设计合理，手术操作简易，调节灵活．组织损伤少．使用安全，可明显消除三叉神经痛。     

经皮穿刺三叉神经半月节射频热凝加得宝松注射治疗原发性三叉神经痛

目的：探讨经皮穿刺三叉神经半月节射频热凝加得宝松注射治疗原发性三叉神经痛的临床疗效。方法：原发性三叉神经痛患者151例,随机分为观察组76例和对照组75例,观察组采用Hartel前入路穿刺法,在CT引导下经皮穿刺三叉神经半月节射频热凝加得宝松注射治疗。对照组采取单纯内科药物治疗。结果：观察组1次射频治疗后达显效54例、有效19例;对照组治疗10 d后,显效及有效分别为47例、17例,观察组总有效率明显高于对照组（96.1%、85.3%,P〈0.05）。随访0.5-2年,观察组复发率明显低于对照组（5.6%、36.2%,P〈0.05）。结论：CT引导下经皮穿刺三叉神经半月节射频热凝加得宝松注射能明显缓解原发性三叉神经痛的临床症状,降低复发率。     

CT三维成像引导下半月神经节射频热凝治疗三叉神经痛

目的 观察CT三维成像引导下经皮卵圆孔穿刺三叉神经半月节射频热凝术治疗三叉神经痛的有效性及安全性.方法 对48例三叉神经痛患者在CT引导下,以前入路法穿刺半月神经节后行射频热凝治疗.结果 48例卵圆孔穿刺均顺利完成,45例治疗后疼痛消失,2例减轻,1例无效.术后随访3 ～18个月,复发1例,46例术后出现面部感觉麻木,7例咀嚼力减弱,无其他并发症.结论 CT三维成像引导经皮卵圆孔穿刺三叉神经半月节射频热凝术治疗三叉神经痛有效、安全.     

经皮穿刺半月神经池注射甘油治疗原发性三叉神经痛（附300例报告）

经皮穿刺半月神经池注射甘油治疗原发性三叉神经痛（附３００例报告）广东省语言听力康复中心甘东荣，郭文祥广东深圳市流花医院门诊部古俊科原发性三叉神经痛目前治疗方法甚多，１９８８年６月～１９９４年６月，我们采用经皮穿刺半月神经池注射甘油方法治疗原发性三叉神...     

同轴技术在CT定位三叉神经半月节射频消融术的临床应用

<正>三叉神经半月节射频消融术是目前治疗原发性三叉神经痛较为有效的方法之一[1,2],然而穿刺中产生的疼痛反应、较高的复发率制约着该技术的普及应用。我科在经过多次对颅底解剖与影像学分析,自2010年3月至2011年2月采用同轴技术的穿刺方法穿刺,进行经皮穿刺CT定位三叉神经半月节射频消融术治疗原发性三叉神经痛29例次,穿刺中一次性到位率100%,复发率较低,疗效满意,     

立体定向辅助射频热凝治疗原发性三叉神经痛

目的探讨立体定向辅助射频热凝治疗原发性三叉神经痛的临床经验。方法回顾性分析45例原发性三叉神经痛患者头部安装立体定向头架后行薄层CT扫描,定位卵圆孔穿刺点X、Y、Z值,然后进入手术室根据所测定值给予行穿刺射频热凝治疗。结果 45例中一次性穿刺成功率97.8%,疗效优良率95.6%,显著缩短了手术时间,避免了反复穿刺及并发症的发生。结论立体定向直接定位三叉神经半月节,显著提高了穿刺的准确性和治疗效果。     

CT引导和非引导下半月神经节毁损术治疗三叉神经痛

目的：比较CT引导与非CT引导下经皮穿刺，用阿霉素毁损三叉神经半月节治疗三叉神经痛的疗效和并发症。方法：89例原发性三叉神经痛患者，男35例，女54例，年龄39～81岁，平均60．4岁，病程1～16年不等，分为两组。治疗前CT冠状及轴位扫描卵圆孔，除外继发性三叉神经痛。第一组(44例)不用CT引导穿刺半月神经节，第二组(45例)用CT引导穿刺的方向并确认针尖的位置，经造影确保穿刺针准确位于半月神经节内，两组均向半月神经节注射阿霉素。结果：治疗后12个月，两组分别有26例和36例完全无痛，分别有17例和6例未缓解。第一组的并发症数量及程度明显超过第二组。结论：与传统的盲目穿刺方法相比，CT引导下经皮穿刺半月神经节毁楣术对三叉神终痛的疗效更好．并发症更少。     

卵圆孔前局麻三叉神经射频热凝术177例术中镇痛及术后疗效观察

三叉神经痛(trigeminal neuralgia,TN)是指头面部三叉神经分布区域内的阵发性疼痛。经卵圆孔三叉神经半月节射频热凝术治疗三叉神经痛是临床的有效疗法之一。我院自2009年02月至2011年12月共收治了177例单侧原发性三叉神经痛患者,均在三维CT引导下于卵圆孔前局部麻醉行三叉神经半月节射频热凝术,现将其术中镇痛效果及术后疗效进行回顾性分析汇报如下。     

三叉神经痛合并高血压患者射频热凝治疗的护理

目的探讨射频热凝术治疗三叉神经痛合并高血压患者的护理体会。方法分析14例患者在C型臂X光机定位下经皮穿刺三叉神经半月节射频热凝毁损术治疗三叉神经痛合并高血压的护理。术前做好充分准备,特别是疼痛正性教育、商血压的护理;术后严密观察血压、疼痛的变化;同时,做好并发症的观察及预防,进行出院指导和随访。结果14例患者手术后均取得满意疗效,不仅疼痛显著缓解,而且高血压碍以有效控制。结论射频热凝术及科学合理的护理措施对治疗三叉神经痛合并高血压具有良好的效果。     

Neuronavigation-assisted percutaneous radiofrequency thermocoagulation therapy in trigeminal neuralgia

OBJECTIVE: To evaluate the roles of neuronavigation-assisted percutaneous radiofrequency thermocoagulation therapy in patients with primary trigeminal neuralgia (TN). METHODS: Neuronavigation technique was applied in 12 consecutive patients who underwent percutaneous radiofrequency thermocoagulation therapy for their primary TN. RESULTS: Neuronavigation assistance ensured precise puncture of oval foramen and successful targeting of trigeminal nerve ganglion in all 12 patients during percutaneous radiofrequency thermocoagulation therapy and resulted in 100% of acute cure rate of TN without major complications. CONCLUSIONS: Neuronavigation is a very useful tool during percutaneous radiofrequency thermocoagulation therapy in patients with primary TN.     

CT引导下经皮穿刺卵圆孔阻滞治疗三叉神经痛

目的探讨CT引导下三叉神经毁损疗法治疗三叉神经痛的方法及临床应用.方法 CT引导机为西门子AR型NOVR型.34例患者均根据典型的病史、体征作出三叉神经痛诊断,均有服用药物史,5例为经其他方法治疗后复发.34例中男8例,女26例,年龄55～70岁,平均58岁.CT引导下经皮穿刺卵圆孔,采用22G穿刺针,CT引导进针,确定针尖在卵圆孔时,分次缓慢注射2%阿霉素0.2～0.3 ml(不超过 0.5 ml).结果治疗后观察疗效及并发症,即刻疼痛减轻26例(76.9%),治疗后6个月,32例疼痛消失,2例疼痛减轻.并发症少而轻微,无严重并发症.结论 CT引导下经皮穿刺卵圆孔疗法治疗三叉神经痛是一种微创、疗效好、可重复操作的新技术,值得临床推广应用.     

C形臂结合皮区刺激电位引导穿刺行三叉神经半月节射频治疗

目的:研究C形臂后前位 正侧位影象结合皮区刺激电位引导穿刺行半月神经节射频治疗的临床优缺点。方法:按入院顺序选择20例原发性三叉神经痛患者为研究对象,C形臂后前位 正侧位影象指导下前外侧入路穿刺卵圆孔,记录低频电刺激下三叉神经三个分支支配区的皮肤电位,依电位强弱决定穿刺针深度和方向再行射频热凝毁损。随机选择前期15例盲穿半月神经节射频毁损患者和15例单纯C形臂定位半月神经节射频毁损患者为对照,比较穿刺过程顺利程度和近、中期疗效。结果:C形臂结合皮区刺激电位引导穿刺行半月神经节射频治疗穿刺次数少,但总治疗操作时间延长,患者的近中期疗效显著优于其它对照组。结论:C形臂结合皮区刺激电位引导穿刺行半月神经节射频治疗显著提高了治疗质量。     

Diagnosis and treatment of trigeminal neuralgia

Trigeminal neuralgia is a disease affecting older individuals. The clinical hallmark of trigeminal neuralgia is a sudden, excruciating paroxysm of pain in the area of the trigeminal nerve. Drug therapy is considered the first line of treatment for trigeminal neuralgia. Anticonvulsant carbamazepine has been used. If relevant pharmacotherapy has been tried without any effect, other procedures are selected. These procedures are microvascular decompression(a radical technique), glycerol trigeminal rhizotomy, percutaneous trigeminal nerve decompression and nerve block. Nerve block with neurolytic solutions and radiofrequency thermocoagulation is a simple, less invasive therapy. In order to avoid hypesthesia and dysesthesia, nerve block using a high concentration of local anesthetics is recommended. In recent years, stereotactic radiosurgery for trigeminal neuralgia has emerged as a new therapeutic modality.     

Coexistence of TACS and trigeminal neuralgia: pathophysiological conjectures

BACKGROUND: Trigeminal autonomic cephalgias (TACs) and trigeminal neuralgia are short-lasting unilateral primary headaches whose study is providing insights into craniofacial pain mechanisms. We report on 2 patients in whom trigeminal neuralgia coexists with the TACs paroxysmal hemicrania and SUNCT. CONCLUSION: Coexistence of trigeminal neuralgia with various TAC forms suggests a pathophysiological relationship between these short-lasting unilateral headaches.     

Increased HCN Channel Activity in the Gasserian Ganglion Contributes to Trigeminal Neuropathic Pain

Orofacial neuropathic pain caused by trigeminal nerve injury is a debilitating condition with limited therapeutic options. Hyperpolarization-activated cyclic nucleotide-gated (HCN) channels regulate neuronal excitability and are involved in the development and maintenance of chronic pain. However, the effect of HCN channel activity in the Gasserian ganglion on trigeminal neuropathic pain has not been examined. We evaluated nociceptive behaviors after microinjection of the HCN channel blockers ZD7288 or ivabradine into the Gasserian ganglion in rats with trigeminal nerve injury. Both blockers dose-dependently ameliorated evoked and spontaneous nociceptive behavior in rats with trigeminal neuropathic pain. Moreover, the clinically available HCN channel blocker ivabradine showed a prolonged antinociceptive effect. In the Gasserian ganglion, HCN1 and HCN2 are major HCN isoforms. After trigeminal nerve injury, the counts of HCN1 as well as HCN2 immuno-positive punctae were increased in the ipsilateral Gasserian ganglions. These results indicate that the increased HCN channel activity in the Gasserian ganglion directly contributes to neuropathic pain resulting from trigeminal nerve injury.

Efficacy and safety of high concentration lidocaine for trigeminal nerve block in patients with trigeminal neuralgia

AIMS: Local anaesthetics, which act as neurolytics and Na(+) channel blockers, have been used for disrupting the neural firings in certain neuropathic pain conditions. This study was undertaken to investigate the clinical outcome of trigeminal nerve block with 10% lidocaine in the management of trigeminal neuralgia (TN). METHODS: Thirty-five patients with primary TN received trigeminal nerve blocks with 10% lidocaine. Success was defined as complete pain relief or mild pain without medication 1 day after the treatment. We followed the patients up every 2 months assessing for pain recurrence, sensory changes and other complications for a total of 37-45 months (median 43 months). RESULTS: Twelve of the 35 patients (34.3%) responded favourably to the treatment and were considered as success. Eleven patients experienced complete pain relief and one could tolerate pain without medication 1 day after the blocks, which lasted for 3-172 weeks. Four patients experienced mildly decreased sensation in the region of the face supplied by the nerve 1 day after the blocks; however, all recovered normal skin sensation in 6 months. There was neither allodynia nor other sensory discomfort. The pain intensity and current pain duration before treatment were significantly different between the two groups. CONCLUSION: Trigeminal nerve block with high concentration lidocaine (10%) is capable of achieving an intermediate period of pain relief, particularly in patients with lower pain intensity and shorter pain duration prior to the procedure.     

CT引导下经眶—圆孔入路射频热凝治疗第2支三叉神经痛

目的:探讨CT引导下经眶-圆孔穿刺入路在第2支三叉神经痛射频热凝治疗中的安全性和疗效。方法:对64例第2支三叉神经痛患者,先行CT扫描评估和确定穿刺径路。取眶外下缘交界处偏内侧为穿刺点,在CT引导下调整穿刺针的方向和深度,穿刺圆孔并成功定位后,行温控射频热凝治疗。结果:1例因CT扫描评估穿刺困难而改经Hartel前入路穿刺。余63例行经眶-圆孔穿刺,其中60例顺利穿刺达圆孔内和半月神经节,3例仅到达圆孔外口。治疗后疼痛均缓解,除面部麻木外,无严重并发症。结论:CT引导下眶-圆孔入路射频热凝治疗第2支三叉神经痛,定位准确,无严重并发症,安全性和治疗效果良好。     

Subclinical sensory abnormalities in trigeminal neuralgia

Trigeminal neuralgia is considered as a paroxysmal single nerve phenomenon. Abnormal sensory perception has been previously described in 15-25% of patients with clinical examination. Quantitative sensory testing (QST) was used to evaluate sensory perception in patients with idiopathic trigeminal neuralgia (ITN). Nine patients and 10 normal control subjects were evaluated in all six trigeminal branches. QST abnormalities were found in the symptomatic division and in the other two branches on the same side. Minor contralateral changes were also found. Differences consisted of cold and warm hypoaesthesia and higher cold and heat pain thresholds in patients. All differences proved statistically significant. Our findings suggest that trigeminal neuralgia is not only a paroxysmal single nerve disorder, but also that other higher structures may be involved.     

三维CT引导下经皮射频热凝术治疗三叉神经痛

目的评价三维CT引导下经皮卵圆孔穿刺用于治疗三叉神经痛的有效性和安全性。方法40例中、重度三叉神经痛患者,在Hartel前入路穿刺过程中,穿刺针抵达卵圆孔、触及骨质或穿刺深度达6～7cm时停止穿刺,行CT扫描和三维重建,在重建影像的指导下穿刺。结果所有穿刺均成功,疼痛缓解程度和有效率随时间增加,近期治疗有效率为95.00%,无严重并发症。结论在三维CT引导下行经皮卵圆孔穿刺,结合电刺激,可有效提高穿刺和定位效果。