螺旋CT引导半月节脉冲射频治疗三又神经痛的远期疗效观察

目的 观察螺旋CT引导下半月节穿刺脉冲射频治疗三叉神经痛的远期疗效.方法 100例原发性三叉神经痛患者分为研究组(脉冲射频组,n=44)和对照组(射频热凝组,n=56).比较治疗前,治疗后0.5年、1年、2年时的疼痛数字模拟评分(NRS)及临床疗效.结果 治疗后1年内两组NRS无显著性差异,但2年后研究组复发率明显高于对照组(P＜0.01).结论 半月节脉冲射频治疗三叉神经痛安全有效,但远期疗效欠佳.     

不同温度射频热凝术治疗双侧三叉神经痛的对比观察

目的:观察三叉神经痛(trigeminal neuralgia,TN)病人双侧分别采用不同温度进行射频热凝术(radiofrequency thermocoagulation,RFT)的疼痛缓解、并发症及满意度情况。方法:对中国医科大学附属盛京医院疼痛科自2013年1月至2015年12月的3年时间内患有双侧原发性TN的34例病人,进行两侧不同温度的RFT治疗,观察术后疼痛缓解、复发率、并发症及满意度情况。结果:病人出院时疼痛缓解均满意。出院时完全无痛病人在两温度侧分别为97.4%(70℃)及98.2%(75℃);术后1年分别为93.7%,96.7%,术后2年84.0%,92.6%,术后3年84.0%,84.9%。两温度侧分别复发4例,3例。70℃RFT侧面部麻木、咀嚼肌无力及角膜反射减弱发生率及恢复时间均低于75℃RFT(P<0.05),满意度优于75℃RFT(P<0.05)。结论:70℃与75℃射频热凝术均可以有效缓解原发性三叉神经痛,但是,70℃RFT在术后并发症及病人满意度方面均优于75℃RFT。推荐临床采用70℃RFT治疗V2、V3支原发性三叉神经痛。     

DSA引导下射频热凝术治疗原发性三叉神经痛30例围术期护理

目的:探讨DSA引导下射频热凝术治疗原发性三叉神经痛患者的围术期护理方法及效果。方法:将60例行DSA引导下射频热凝术治疗的原发性三叉神经痛患者随机分为观察组和对照组各30例,对照组给予常规术前、术中、术后护理,观察组给予围术期护理,比较两组护理效果。结果:两组疗效及术后感染率、复发率比较差异有统计学意义(P<0.05)。结论:完善的围术期护理可提高DSA引导下射频热凝术治疗原发性三叉神经痛的疗效,降低感染率和复发率。     

C臂机引导下射频热凝术治疗三叉神经痛42例围术期护理

目的:探讨C臂机引导下射频热凝术(RFT)治疗原发性三叉神经痛的围术期护理方法。方法:对42例原发性三叉神经痛患者在中心手术室行C臂机引导下射频热凝术,并给予精心围术期护理。根据VAS评分及疼痛缓解度(PAR)对患者进行效果评估。结果:本组患者疼痛完全缓解38例、缓解2例、未缓解2例,未见术后严重并发症。结论:C臂机引导下射频热凝手术治疗原发性三叉神经痛效果满意,良好的围术期护理可以缓解患者紧张、焦虑情绪,减轻疼痛,有利于促进患者康复,减少术后并发症的发生。     

外周神经射频热凝术治疗三叉神经痛远期疗效

三叉神经痛(trigminal neuralgia)分为原发性和继发性两类,前者无明显病因或三叉神经受血管压迫所致;后者主要由多发性硬化和脑肿瘤所致,借助颅脑CT/MR可初步鉴别二者.本病诊断虽较容易,且治疗方法多种,但每种方法都有一定的局限性和复发率.我们应用加拿大Baylis射频治疗仪,采用标准射频模式行外周神经射频热凝术治疗原发性三叉神经痛,现总结58例患者的治疗效果及远期疗效分析,以探讨该方法治疗原发性三叉神经痛的规律.     

CT引导下经圆孔外口与经卵圆孔行温控射频热凝术治疗原发性三叉神经上颌神经痛的效果比较

目的比较CT引导下经圆孔外口与经卵圆孔行温控射频热凝术治疗原发性三叉神经上颌神经痛的临床效果。方法将72例原发性三叉神经上颌神经痛患者根据术式不同分为对照组(n=36)与研究组(n=36)。研究组采用CT引导下经圆孔外口行温控射频热凝术治疗;对照组采用CT引导下经卵圆孔行温控射频热凝术治疗。比较2组治疗前后疼痛程度及术后并发症发生情况,术后随访6个月,观察2组复发率。疼痛程度采用视觉模拟评分量表(VAS)进行评定。结果 2组治疗前后VAS评分比较差异均无统计学意义(P>0.05),2组治疗后VAS评分均较治疗前显著减少,差异有统计学意义(P<0.05);研究组术后并发症发生率较对照组显著减少(5.56%比36.12%,χ2=10.190、P<0.05),术后复发率与对照组比较差异无统计学意义(5.56%比8.33%,χ2=0.000、P>0.05)。结论 CT引导下经圆孔外口与经卵圆孔行温控射频热凝术治疗原发性三叉神经上颌神经痛均可取得显著疗效,降低疾病复发率,但经圆孔外口行温控射频热凝术并发症发生率较低,安全性更高。     

射频热凝联合牛痘疫苗接种家兔炎症皮肤提取物治疗带状疱疹后遗神经痛

目的:观察射频热凝联合牛痘疫苗接种家兔炎症皮肤提取物(神经妥乐平)治疗带状疱疹后遗神经痛的疗效.方法:将90例胸腰部带状疱疹后遗神经痛(post-herpetic neuralgia,PHN)患者随机分为射频热凝(radiofrequency thermocoagulation,RFT)联合神经妥乐平组(A组,30例)、射频热凝组(B组,30例)、神经妥乐平组(C组,30例),采用视觉模拟评估法(vasual analogue scale,VAS),分别对治疗前、后VAS评分进行统计分析.结果:治疗后VAS比较,A组与B、c两组比较,有统计学意义(P<0.01);治疗后疗效比较,A组与B、c两组比较,有统计学意义(P<0.05、P<0.01).结论:射频热凝联合神经妥乐平有效缓解带状疱疹后遗神经痛,疗效明显优于单纯射频和单纯使用神经妥乐平.     

射频控温热凝治疗原发性三叉神经痛临床疗效观察

目的观察射频温控热凝术治疗原发性三叉神经痛的疗效及安全性。方法 73例原发性三叉神经痛患者按随机数字表法分为治疗组（36例）及对照组（37例）,治疗组采用射频温控热凝术治疗,对照组采用药物或封闭治疗,观察两组的临床治疗效果及安全性。结果治疗组的总有效率为94.4%,明显优于对照组（73.0%）,差异有统计学意义（P〈0.05）。治疗组有2例患者出现面部感觉减退和角膜反射迟钝等不良反应,对照组有2例患者出现药物不良反应。随访6个月,治疗组复发率明显低于对照组（P〈0.05）。结论射频热凝术治疗原发性三叉神经痛疗效好,且安全性高。     

X线引导下穿刺针位于卵圆孔内不同深度射频治疗三叉神经痛疗效观察

<正>三叉神经痛是发生于头面部的剧烈疼痛[1],经皮穿刺卵圆孔行半月神经节射频热凝术是目前治疗三叉神经痛的常用有效方法之一[2],为了研究治疗不同分支的三叉神经痛患者,穿刺针在卵圆孔内的深度有何区别,将我院从2007年1月至2009年6月的309例三叉神经痛患者分析如下。方法1.一般资料309例原发单侧三叉神经痛患者(眼支除外),下颌支疼痛者为A组(n=160例),上、下颌支或单纯上颌支疼痛者为B组(n=149例),年龄     

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。     

McGill疼痛问卷在三叉神经痛诊断和治疗中的应用

目的:通过采用McGill疼痛问卷(McGill pain questionnaire,MPQ)鉴别三叉神经痛,并观察射频热凝术的疗效,研究MPQ在面痛诊断上的重要性。方法:本研究共观察159例三叉神经痛患者,其中136例患有典型三叉神经痛(CTN),23例患有混合型三叉神经痛(MTN)。采用MPQ评估患者的疼痛,并观察其中124例术后患者疼痛的缓解情况。结果:CTN组的平均现有疼痛强度(PPI)值为4.20±0.34,MTN组的平均PPI值为3.50±0.57,明显低于CTN组(P0.001);与MTN患者相比,CTN患者在疼痛分级指数(PRI)-感觉项上报告了更高的强度(P0.001);两组间PRI-情感和PRI-评价项上有明显区别,CTN组的得分更高(P0.001);RFT术后CTN患者显示了高的立即疼痛缓解率,达到93.6%。MTN患者的结果没有CTN组的好,只有58.8%的患者疼痛明显缓解。结论:MPQ可以很好鉴别不同类型的三叉神经痛,鉴于射频热凝治疗两种三叉神经痛疗效的差异,使用MPQ在面痛诊断中有重要意义。     

Pulsed radiofrequency treatment of the Gasserian ganglion in patients with idiopathic trigeminal neuralgia

Pulsed radiofrequency treatment has been described as a minimal invasive alternative to radiofrequency thermocoagulation for the management of chronic pain syndromes. We present here our first five high-risk patients with idiopathic trigeminal neuralgia who were treated with pulsed radiofrequency after multidisciplinary assessment; with a mean follow-up of 19.2 months (range 10-26). These patients were at high risk due to age, co-morbidities or previous interventional and surgical treatments. An excellent long-term effect was achieved in three of the five patients, a partial effect in one patient and a short-term effect in one patient. No neurological side effects or complications were reported.     

Comparison of pulsed radiofrequency with conventional radiofrequency in the treatment of idiopathic trigeminal neuralgia.

The aim of this prospective, randomized, double-blinded study was to evaluate the effect of pulsed radiofrequency (PRF) in comparison with conventional radiofrequency (CRF) in the treatment of idiopathic trigeminal neuralgia. A total of 40 patients with idiopathic trigeminal neuralgia were included. The 20 patients in each group were randomly assigned to one of the two treatment groups. Each patient in the Group 1 was treated with CRF, whereas each patient in the Group 2 was treated by PRF. Evaluation parameters were: pain intensity using a Visual Analogue Scale (VAS), patient satisfaction using a Patient Satisfaction Scale (PSS), additional pharmacological treatment, side effects, and complications related to the technique. The VAS scores decreased significantly (p<0.001) and PSS improved significantly after the procedure in Group 1. The VAS score decreased in only 2 of 20 patients from the PRF group (Group 2) and pain recurrence occurred 3 months after the procedure. At the end of 3 months, we decided to perform CRF in Group 2, because all patients in this group still had intractable pain. After the CRF treatment, the median VAS score decreased (p<0.001) and PSS improved (p<0.001) significantly. In conclusion, the results of our study demonstrate that unlike CRF, PRF is not an effective method of pain treatment for idiopathic trigeminal neuralgia.     

CT引导下半月神经节射频热凝加阿霉素毁损治疗三叉神经痛的疗效分析

目的观察CT引导下半月神经节射频热凝加阿霉素毁损治疗三叉神经痛的远近期疗效。方法对68例三叉神经痛患者CT引导下行半月神经节射频热凝加阿霉素毁损治疗。观察并记录术前后的疼痛视觉模拟评分(VAS),进行疗效评估,并随访2年,观察复发率。结果治疗后各时段VAS评分均降低,差异有统计学意义(P0.05);术后7 d后各时段与术后1 d疼痛VAS评分差异有统计学意义(P0.05);术后30 d后各时段与术后7 d疼痛VAS评分差异无统计学意义(P0.05);术后疗效各时段相比,差异无统计学意义(P0.05)。结论 CT引导下半月神经节射频热凝加阿霉素毁损治疗三叉神经痛,可以提高疗效,降低复发率,减少并发症,是一种治疗三叉神经痛的安全有效方法。     

经侧方入路与经卵圆孔三叉神经下颌支介入射频热凝术的临床比较

目的:对经侧方入路与经卵圆孔神经射频热凝术治疗原发性三叉神经下颌支顽固性疼痛进行临床比较.方法:2003年6月-2007年6月,68例原发性三叉神经下领支顽固性疼痛患者被纳入,随机分成两组,分别在DSA介导下进行经侧方入路或经卵圆孔三叉神经下颌支射频热凝术.利用视觉模拟评分法(VAS)进行各自术前与术后不同时段疗效评定...     

Treatment of idiopathic trigeminal neuralgia: comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompression. (Heidelberg College of Medicine, Heidelberg, Germany) Neurosurgery. 2001;48:1261–1267.

The purpose of this study was to evaluate the long‐term outcome of patients after either percutaneous trigeminal rhizotomy or microvascular decompression (MVD) for idiopathic trigeminal neuralgia at a single institution. Overall, the results of the study showed that there was a 50% risk of recurrence of pain 2 years after percutaneous radiofrequency rhizotomy. Conversely, 64% of the patients who underwent MVD remained completely pain free 20 years postoperatively. Patients without sensory impairment after MVD were pain free significantly longer than patients who experienced postoperatively hypesthesia or partial rhizotomy. Conclude that because it is curative and nondestructive, MVD is considered the treatment of choice for trigeminal neuralgia in otherwise healthy people. In this study, it was proved to be a more effective and long‐lasting procedure for patients with typical trigeminal neuralgia than radiofrequency rhizotomy. Patients without postoperative sensory deficit remained pain free significantly longer, which is a strong argument against the “trauma” hypothesis of this procedure. Comment by Ron Pawl, M.D. This paper is noteworthy in that comparing the follow‐up on 225 of 378 patients who underwent microvascular decompression (MVD) with 206 of 316 who underwent radiofrequency thermocoagulation (RFT), the RFT group stood a 50% risk of recurrent pain by 2 years after the procedure, whereas 64% of those undergoing MVD were pain‐free after 20 years. Furthermore, after MVD, those patients with no postoperative sensory deficit, measured with von Frey hairs, remained pain‐free longer than those with a sensory deficit. This latter finding flies in the face of the concept that to be effective, surgery for trigeminal neuralgia must damage the nerve. The whole concept of RF lesioning of the nerve is to damage it enough to deaden the trigger zone of the affected nerve branch. However, in this study it is noted that postoperative hypesthesia was only temporary after RF lesioning, which might well explain the high rate of pain recurrence in this series. Although the long‐term pain relief in the MVD group is excellent, it must be weighed against the complications. In the MVD group, there were 3 mortalities, diminished hearing in 5%, loss of hearing in 2.6%, facial paralysis in 4 patients, and tinnitus in 4 patients, none of which occurred in the RF group.     

CT引导下颈侧入路射频热凝合并无水乙醇毁损术治疗舌咽神经痛

目的 探讨CT引导下颈侧入路舌咽神经射频热凝合并无水乙醇毁损术对舌咽神经痛的疗效。 方法 对35例舌咽神经痛患者在CT引导下采用颈侧入路经皮穿刺,进行舌咽神经射频热凝合并无水乙醇毁损术,观察术前、术后1周及出院随访时的疼痛情况、情绪评分以及并发症。 结果 28例患者术后疼痛消失,4例术后疼痛减轻,余3例合并三叉神经痛患者术后接受半月神经节射频毁损术,术后疼痛消失。随访期间30例疼痛消失无复发,2例在出院1个月内疼痛消失,1例部分缓解,2例患者术后6个月复发。所有患者视觉模拟评分疼痛与情绪评分明显降低,无严重并发症发生。 结论 CT引导下颈侧入路射频热凝合并无水乙醇毁损术治疗舌咽神经痛安全、疗效可靠,定位准确,可有效降低严重并发症的发生率。