CT引导经皮穿刺射频温控热凝半月神经节治疗老年原发性三叉神经痛：与<60岁患者3年随访结局比较

We evaluated the immediate and long-term clinical efficacy of computed tomography (CT)-guided radiofrequency thermocoagulation for primary trigeminal neuralgia (RTPTN) in 852 patients includ-ing 502 patients aged ≥ 60 years and 350 patients aged < 60 years.After discharge,the incidence of complications was 1.0% and 0.9% in patients aged ≥ 60 years and patients aged < 60 years,respectively.Over 3-year follow-up after CT-guided RTPTN,96.8% of the patients aged ≥ 60 years and 98.6% of the patients aged < 60 years were completely pain-free,and there was no significant difference between these two age brackets.In addition,there were no significant differences in quality of life scores and numbness scores between these two age brackets.These findings suggest that CT-guided RTPTN is a safe and effective method and is recommended for older and poor-risk patients.     

半月节立体定向毁损治疗三叉神经痛(附124例报告)

目的 探讨CRW立体定向导航系统以及三维CT在三叉神经半月节射频热凝术中的应用价值.方法 广东省第二人民医院自2007年7月至2009年12月共收治124例原发性三叉神经痛患者,均采用CRW立体定向系统辅助下经皮穿刺卵圆孔,再在三维CT辅助下进针到达半月节切迹,方波刺激及预毁损确认穿刺到位后,采取逐渐加温的方式进行毁损.结果 124例患者均穿刺成功,无穿刺副损伤所致并发症.一次穿刺成功89例(71.8%),二次穿刺成功33例(26.6%),2例(1.6%)因颅底骨质结构有变异,经多次穿刺成功.术后即刻总体有效率为98.4%.术后出现患侧面部麻木感即浅感觉减退87例(70.2%),1例患者出现角膜炎(0.8%),未出现复视、咀嚼无力、张口困难等并发症.所有患者随访3月～2年,复发7例(5.6%).结论 采用立体定向导航系统及三维CT重建可以大大提高穿刺卵圆孔的准确性,减少并发症:个体化穿刺策略的制定可以进一步确保疗效,提高治愈率.     

半月节立体定向毁损治疗三叉神经痛(附124例报告)

目的 探讨CRW立体定向导航系统以及三维CT在三叉神经半月节射频热凝术中的应用价值.方法 广东省第二人民医院自2007年7月至2009年12月共收治124例原发性三叉神经痛患者,均采用CRW立体定向系统辅助下经皮穿刺卵圆孔,再在三维CT辅助下进针到达半月节切迹,方波刺激及预毁损确认穿刺到位后,采取逐渐加温的方式进行毁损.结果 124例患者均穿刺成功,无穿刺副损伤所致并发症.一次穿刺成功89例(71.8%),二次穿刺成功33例(26.6%),2例(1.6%)因颅底骨质结构有变异,经多次穿刺成功.术后即刻总体有效率为98.4%.术后出现患侧面部麻木感即浅感觉减退87例(70.2%),1例患者出现角膜炎(0.8%),未出现复视、咀嚼无力、张口困难等并发症.所有患者随访3月～2年,复发7例(5.6%).结论 采用立体定向导航系统及三维CT重建可以大大提高穿刺卵圆孔的准确性,减少并发症:个体化穿刺策略的制定可以进一步确保疗效,提高治愈率.     

三叉神经痛合并根区蛛网膜粘连的病毒病因学研究

Objective To assess the relationship that trigeminal neuralgia combining arachnoids' adhesions and herpes simplex virus type 1. Methods There are fifty nine patients with trigeminal neuralgia their trigeminal nerve root area combined arachnoids' adhesion, cutting their arachnoids as the experimental group. There are twenty four patients with trigeminal neuralgia their trigeminal nerve root area is not combined significant arachnoids' adhesion, cutting their arachnoids as the case - control group. Using polymerase chain reaction and Western blot technique to detecting the HSV - 1 specific DNA fragments and specific antigen,and cutting twenty arachnoids of the patients with Brain Trauma as the normal control group. Results The positive ratio of DNA fragments in the three group is 69% 、58% and 25% respectively. The positive ratio of DNA fragments in the experiment group and case -control group were higher than the normal control group,with statistical difference ( P ＜ 0. 05 ), but the experimental group and case -control group compared with no significant difference ( P ＞ 0. 05 ). The positive ratio of virus - specific antigen is 51%、 25 % and 15 %respectively. The positive ratio of virus - specific antigen was higher than the case - control group, also higher than the normal control group, were significantly different ( P ＜ 0. 05 ), while the case - control group and the normal control group compared with no significant differences ( P ＞ 0. 05 ). Conclusion HSV - 1 proliferating infected patients with trigeminal neuralgia may result in the arachnoids adhesion of trigeminal nerve root zone; arachnoids tissue may be another latent base of HSV - 1; HSV - 1 infection may be another pathogenic factor of trigeminal neuralgia.     

三叉神经痛合并根区蛛网膜粘连的病毒病因学研究

Objective To assess the relationship that trigeminal neuralgia combining arachnoids' adhesions and herpes simplex virus type 1. Methods There are fifty nine patients with trigeminal neuralgia their trigeminal nerve root area combined arachnoids' adhesion, cutting their arachnoids as the experimental group. There are twenty four patients with trigeminal neuralgia their trigeminal nerve root area is not combined significant arachnoids' adhesion, cutting their arachnoids as the case - control group. Using polymerase chain reaction and Western blot technique to detecting the HSV - 1 specific DNA fragments and specific antigen,and cutting twenty arachnoids of the patients with Brain Trauma as the normal control group. Results The positive ratio of DNA fragments in the three group is 69% 、58% and 25% respectively. The positive ratio of DNA fragments in the experiment group and case -control group were higher than the normal control group,with statistical difference ( P ＜ 0. 05 ), but the experimental group and case -control group compared with no significant difference ( P ＞ 0. 05 ). The positive ratio of virus - specific antigen is 51%、 25 % and 15 %respectively. The positive ratio of virus - specific antigen was higher than the case - control group, also higher than the normal control group, were significantly different ( P ＜ 0. 05 ), while the case - control group and the normal control group compared with no significant differences ( P ＞ 0. 05 ). Conclusion HSV - 1 proliferating infected patients with trigeminal neuralgia may result in the arachnoids adhesion of trigeminal nerve root zone; arachnoids tissue may be another latent base of HSV - 1; HSV - 1 infection may be another pathogenic factor of trigeminal neuralgia.     

Effect of percutaneous radiofrequency thermocoagulation on different neuropathic pains

BACKGROUND: The clinical treatment of neuropathic pain is very troublesome, and the physical method of radiofrequency thermocoagulation is a good choice for its treatment. OBJECTIVE: To observe the curative effect of percutaneous radiofrequency thermocoagulation on neuropathic neuralgia. DESIGN: A case follow-up analysis. SETTING: Minimally Invasive Surgery Room, Department of Neurosurgery, Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA. PARTICIPANTS: Totally 131 patients were selected from the Department of Neurosurgery, Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA from December 2000 to June 2006, including 73 males and 58 females, aging 37-72 years old, AND the disease course was 2-15 years. ① Drug treatment failed to alleviate the pain or induced obvious side effects; ② With the same pathological changes as pain and effective in the nerve block test; Had signed the informed consents before treatment. Distribution of the neuropathic pain: ① Trigeminal neuralgia, which were lighting attack, located at V2 in 28 cases, V3 in 46 cases, V1 V2 in 3 cases, V2 V3 in 28 cases, and V1 V2 V3 in 1 case; ② Migraine located at (except the frontal branch of trigeminal nerve) greater and lesser occipital nerves in 6 cases, auriculotemporal nerve in 3 cases, temporal and zygomatic nerves in 3 cases; ③ Unilateral neuralgia of C2 and C3 following herpes zoster in 1 case, and chest intercostals neuralgia in 2 cases; ④ Lasting burning pain in the operative area after thoracotomy was in 1 case of lung cancer. METHODS: ① All the enrolled patients were treated with percutaneous puncture at trigeminal ganglion or peripheral nerve, then nerve block was performed firstly for anesthesia, and the pain disappeared immediately at this moment, there was hypoesthesia or numbness in the area of innervation, which manifested the puncture apposition was correct, then electrostimulation of 50 Hz with the current of 0.1-0.5 V was given for further functional localization. ② The RFG-3C radiofrequency therapeutic instrument (Radionics, USA) was used, the tip of the radiofrequency electrode was exposed for 5 mm, the temperature was kept at 80-85 ℃, 30-60 for each time, and treated for 3 or 4 times. The neuralgia following herpes zoster could also be treated by thermocoagulation at several points. ③ Evaluation standards for the therapeutic efficacy: Excellent meant the pain disappeared completely without taking any anodyne. Good referred to the pain was alleviated as compared with the preoperative one, and it could be effectively controlled by anodyne at relapse, but radiofrequency therapy was unnecessary. MAIN OUTCOME MEASURES: Therapeutic efficacy of neuropathic neuralgia of different types after treatment of percutaneous radiofrequency thermocoagulation. RESULTS: All the 131 patients were involved in the final analysis of results, no one missed. ① Therapeutic efficacy: In the 24-month follow-up, the therapeutic efficacy was excellent in 106 cases (80.9%), good in 21 cases (16.0 %) and had no change in 4 cases (3.1%). For 13 of the patients with trigeminal neuralgia, the pain relapsed after the lesion of peripheral branches, and it disappeared after the second treatment. The treatment was invalid for 1 patient with lung cancer suffering from pain in the operative area after thoracotomy, and the pain was alleviated by spinal cord stimulation. The pain disappeared after treated for 3 times in the patients with cervical neuralgia following herpes zoster. ② The pain relapsed in 28 cases (21.4%) at 12 months of the follow-up. ③ Adverse events and side effects: Except the hypoesthesia of different severity at the site of pain, there was no other complication after treatment. CONCLUSION:The follow-up results showed that percutaneous radiofrequency thermocoagulation is one of the effective methods for treating neuropathic neuralgias of various types.     

Effect of percutaneous radiofrequency thermocoagulation on different neuropathic pains

BACKGROUND: The clinical treatment of neuropathic pain is very troublesome ,and the physical method of radiofrequency thermocoagulation is a good choice for its treatment.OBJECTIVE: To observe the curative effact of percutaneous radiofrequency thermocoagulation on neuropathic neuralgia.DESIGN:A case follow-up analysis.SETTING: Minimally Invasive Surgery Room,Department of Neurosurgery,Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA.PARTICIPANTS: Totally 131 patients were selected from the Department of Neurosurgery,Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA from December 2000 to June 2006,including 73 males and 58 females,aging 37-72 years old,AND the disease course was 2-15 years.①Drug treatment failed to alleviate the pain or induced obvious side the pain or induced obvious side effects; ②With the same pathological changes as pain and effective in the nerve block test; Had signed the informed consents before treatment.Distribution of the neuropathic pain:①Trigeminal neuralgia,which were lighting attack,located at V2 in 28 cases,V3 in 46 cases,V1 V2 in 3 cases,V2 V3 in 28 cases,and V1 V2 V3 in 1 cases;②Migraine located at(except the frontal branch of trigeminal nerve)greater and lesser occipital nerves in 6 cases,auriculotemporal nerve in 3 cases,temporal and zygomatic nerves in 3 cases;③Unilateral neuralgia of C2 and C3 following herpes zoster in 1 case,and chest intercostals neuralgia in 2 cases;④Lasting burning pain in the operative area after thoracotomy was in 1 case of lung cancer.METHODS: ①All the enrolled patients were treated with percutaneous puncture at trigeminal ganglion or peripheral nerve,then nerve block was performed firstly for anesthesia,and the pain disappeared immediately at this moment,there was hypoesthesia or numbness in the area of innervation,which manifested the puncture apposition was correct.then electrostimulation of 50 Hz with the current of 0.1-0.5 V was given for further functional localization.②The RFG-3C radiofrequency therapeutic instrument(Radionics,USA)was used,the tip of the radiofrequency electrode was exposed for 5 mm,the temperature was kept at 80-85℃,30-60 for each time, and treated for 3 or 4 times.The neuralgia following herpes zoster could also be treated by thermocoagulation at several points.③Evaluation standards for the therapeutic efficacy:Excellent meant the pain disappeared completely without taking any anodyne. Good referred to the pain was alleviated as compared with the preoperative one, and it could be effectively controlled by anodyne at relapse, but radiofrequency therapy was unnecessary.MAIN OUTCOME MEASURES:Therapeutic efficacy of neuropathic neuralgia of different types after treatment of percutaneous radiofrequency thermocoagulation.RESULTS:All the 131 patients were involved in the final analysis of results,no one missed.④Therapeutic efficacy:In the 24-month follow-up,the therapeutic efficacy was excellent in 106 cases(80,9%),good in 21 cases(16.0%)and had no change in 4 cases(3.1%).For 13 of the patients with trigeminal neuralgia,the pain relapsed after the lesion of peripheral branches,and it disappeared after the second treatment.The treatment was invalid for 1 patient with lung cancer suffering from pain in the operative area after thoracotomy,and the pain was alleviated by spinal cord stimulation.The pain disappeared after treated for 3 times in the patients with cervical neuralgia following herpes zoster.②The pain relapsed in 28 cases(21.4%)at 12 months of the follow-up.③Adverse events and side effects:Except the hypoesthesia of different severity at the site of pain,there was no other complication after treatment.CONCLUSION:The follow-up results showed that percutaneous radiofrequency thermocoagulation is one of the effective methods for treating neuropathic neuralgias of various types.     

微血管减压术治疗三叉神经痛74例疗效分析

目的 探讨微血管减压术治疗三叉神经痛(TN)的临床疗效和并发症.方法 武警江苏总队南京医院口腔科自2002年8月至2009年4月共行微血管减压术治疗TN患者74例,回顾性分析患者的临床资料和疗效.结果 本组患者术后均临床治愈出院,无死亡病例.术后颅内血肿1例(1.35%),术侧小脑水肿致非交通性脑积水1例(1.35%),颅内感染2例(2.7%),均经积极对症治疗后缓解.全部患者随访3个月～6年,无复发病例,遗留术侧轻微面瘫2例(2.7%),听力轻度下降1例(14%).结论 微血管减压术解除了TN的常见病因,保留三叉神经的功能,是治疗TN的首选方法.

Abstract：

Objective To investigate the clinical effect of microvascular decompression on patients with trigeminal neuralgia (TN) and its complications. Methods A retrospective analysis of 74 patients with microvascular decompression, admitted to our hospital from August 2002 to April 2009,was performed; the clinical data and thc treatment efficacy were analyzed. Results The total effective rate was 100% without death. Intracranial hematoma appeared in 1 patient (1.35%); edema of the cerebellum in the operated side caused 1 patient (1.35%) having non-communicating hydrocephalus and 2 (2.7%) having intracranial infection, and all were relieved symptoms after treatment. All patients were followed up for 3 months to 6 years; no recurrence was noted; facial paralysis in 2 (2.7%) and slight hearing-loss in 1were found. Conclusion Microvascular decompression, lifting the common cause of TN and fully retaining the function of trigeminal nerve, is the preferred method for treatment of TN.     

磁共振断层血管成像及神经内镜在判断原发性三叉神经痛病因中的作用

目的 探讨磁共振断层血管成像(MRTA)及神经内镜在判断原发性三叉神经痛病因中所起的作用. 方法 回顾性分析行微血管减压术治疗的49例原发性三叉神经痛患者的临床资料、影像学资料及手术资料.所有患者术前均行MRTA检查,术中垫入隔片前置入30°神经内镜行多角度观察. 结果 本组患者MRTA阳性率为77.6%(38/49),MRTA检测为阳性者在术中均得到证实,无一例假阳性.4例术中无法判别可疑血管是否为责任血管者应用神经内镜予以了明确.49例患者中术后47例(95.9%)疼痛消失,1例(2.0%)疼痛减轻,总有效率为97.9%. 结论 MRTA及神经内镜技术有助于判断原发性三叉神经痛的病因,提高手术的安全性和有效性.

Abstract：

Objective To explore the role of magnetic resonance tomographic angiography (MRTA) and neuroendoscope in determining the etiology of idiopathic trigeminal neuralgia. Methods Forty-nine patients with idiopathic trigeminal neuralgia, performed microvascular decompression were chosen; their clinical data, imaging data and operative data were retrospectively analyzed. All patients underwent preoperative MRTA; and before placing intraoperative Teflon, 30° neuroendoscope was applied for multi-angle exploration. Results Positive rate reached 77.6% under MRTA. All patients with positive results under MRTA were confirmed, without a false-positive. Neuroendoscope helped to determine whether the suspect vessels were the offending vessels in 4 patients. The total effective rate in 49 patients was 97.9%; pain disappeared in 47 patients (95.9%) and pain relieved in 1 (2.0%).Conclusion MRTA and neuroendoscope can help to determine the etiology of idiopathic trigeminal neuralgia, and improve the safety and effectiveness of MVD.     

三叉神经痛合并根区蛛网膜粘连的病毒病因学研究

目的 探讨原发性三叉神经痛(TN)合并根区蛛网膜粘连与HSV-1感染的关系.方法 对TN患者于显微血管减压术中见其三叉神经根区合并蛛网膜粘连者59例,取其蛛网膜作为实验组;未合并根区明显蛛网膜粘连的TN患者24例,取其蛛网膜作为病例对照组;采用PCR和Western Blot方法分别检测其HSV-1特异性DNA片段、特异性抗原,并以20例外伤患者蛛网膜做正常对照.结果 三组资料中DNA片段阳性率分别为:69%、58%和25%;实验组和病例对照组的DNA片段阳性率均高于正常对照组,且差异有统计学意义(P＜0.05),但实验组和病例对照组相比差异无统计学意义(P＞0.05);病毒特异性抗原阳性率分别为:51%、25%和15%,实验组病毒抗原阳性率高于病例对照组,也高于正常对照组,差异有统计学意义(P＜0.05),而病例对照组和正常对照组相比差异无统计学意义(P＞0.05).结论 HSV-1病毒增殖性感染可能促使TN患者三叉神经根区蛛网膜的粘连,蛛网膜组织可能是HSV-1潜伏感染的另一基地;HSV-1病毒感染可能是TN又一致病因素.

Abstract：

Objective To assess the relationship that trigeminal neuralgia combining arachnoids' adhesions and herpes simplex virus type 1. Methods There are fifty nine patients with trigeminal neuralgia their trigeminal nerve root area combined arachnoids' adhesion, cutting their arachnoids as the experimental group. There are twenty four patients with trigeminal neuralgia their trigeminal nerve root area is not combined significant arachnoids' adhesion, cutting their arachnoids as the case - control group. Using polymerase chain reaction and Western blot technique to detecting the HSV - 1 specific DNA fragments and specific antigen,and cutting twenty arachnoids of the patients with Brain Trauma as the normal control group. Results The positive ratio of DNA fragments in the three group is 69% 、58% and 25% respectively. The positive ratio of DNA fragments in the experiment group and case -control group were higher than the normal control group,with statistical difference ( P ＜ 0. 05 ), but the experimental group and case -control group compared with no significant difference ( P ＞ 0. 05 ). The positive ratio of virus - specific antigen is 51%、 25 % and 15 %respectively. The positive ratio of virus - specific antigen was higher than the case - control group, also higher than the normal control group, were significantly different ( P ＜ 0. 05 ), while the case - control group and the normal control group compared with no significant differences ( P ＞ 0. 05 ). Conclusion HSV - 1 proliferating infected patients with trigeminal neuralgia may result in the arachnoids adhesion of trigeminal nerve root zone; arachnoids tissue may be another latent base of HSV - 1; HSV - 1 infection may be another pathogenic factor of trigeminal neuralgia.     

无框架立体定向引导射频热凝治疗原发性三叉神经痛

目的观察无框架立体定向引导射频热凝治疗原发性三叉神经痛的临床疗效。方法在无框架立体定向手术系统引导下,对30例原发性三叉神经痛病人行经前入路卵圆孔穿刺半月神经节,术中电刺激验证靶点,而后进行靶点射频热凝治疗。结果一次性穿刺成功率100％。随访6～36个月,疼痛完全消失29例,疼痛减轻1例;术后出现面部麻木8例,咀嚼力减弱1例,无其他严重并发症。结论无框架立体定向引导射频热凝治疗原发性三叉神经痛,可明显减少盲穿过程因深度或方向掌握不当产生的并发症,一次性穿刺成功率高,效果显著。     

神经导航引导经皮穿刺三叉神经半月节射频热凝治疗三叉神经痛的研究

目的 探讨神经导航引导下经皮穿刺三叉神经半月节射频热凝术在治疗三叉神经痛中的应用.方法 选取我科神经导航引导下经皮穿刺三叉神经半月节射频热凝治疗的156例患者资料.所有患者术前均经头部3D-CT薄层连续平扫,并将影像资料导入SteahhStation Tria Plus手术导航系统,图像经三维重建后,确认患侧卵圆孔作为靶点,在导航实时引导下进行卵圆孔穿刺,并行电生理测试,再次确认靶点的位置无误后,进行射频热凝治疗.结果 所有患者顺利穿刺成功,射频热凝术后,患者原有的面部疼痛均明显缓解或消失,术前患者VAS评分为9.67±0.47,术后VAS评分为0.22±0.57,差异有明显的统计学意义,且所有患者术后均无严重并发症.结论 神经导航引导下经皮穿刺三叉神经半月节射频热凝术是一种微创,安全和疗效显著的三叉神经痛外科治疗手段.     

经颌下-卵圆孔入路穿刺射频热凝治疗三叉神经痛

目的 探讨经颌下-卵圆孔入路穿刺射频热凝治疗三叉神经第Ⅲ支病变导致的原发性三叉神经痛的可行性和有效性。方法 2016年1月至2017年4月收治三叉神经第Ⅲ支病变导致的原发性三叉神经痛40例,采用经颌下-卵圆孔入路20例,采用Hartel前入路20例。两组均在三维CT定位下穿刺卵圆孔,定位成功后,行温控射频热凝治疗。结果 两组术后各有1例治疗无效,有效率均为95%,未见严重的并发症和其他神经损伤。两组手术时间大致相同（P>0.05）。术后6个月随访,疼痛缓解效果相同（P>0.05）。结论 三维CT定位下,经颌下-卵圆孔入路方法治疗三叉神经第Ⅲ支病变导致的原发性三叉神经痛具有可行性和有效性,并且可弥补Hartel前入路方法的局限。     

立体定向射频热凝治疗三叉神经痛的心血管反应

目的探讨立体定向导航下经皮穿刺射频热凝术治疗三叉神经痛中,对心血管所产生的副作用。方法对256原发性三叉神经痛患者采用立体定向导航技术对三叉神经半月节进行经皮穿刺热凝毁损,术中全程监测患者的心率、血压及心电图。结果所有256例(100%)患者进行射频毁损治疗中均出现不同程度的心率及血压的升高,静脉应用硝酸甘油调控效果良好。在穿刺卵圆孔过程中有22例(8.6%)患者出现即时的不同程度的心率和血压的降低(最低心率60次/min有12例(4.7%),最低心率≥60次/min有10例(3.9%),对心率下降但心率≥60次/min的患者采用立刻终止手术操作,患者心率可以逐渐好转。对心率下降并且心率60次/min的患者静脉注射阿托品干预后,患者心率能恢复正常。结论经皮穿刺半月节射频热凝术治疗三叉神经痛,术中进行持续的心电监测可以实时了解心率及血压变化,立即予以停止手术操作和药物干预可以有效避免严重心血管事件的发生。     

重复伽玛刀治疗原发性三叉神经痛的临床研究

目的 探讨重复伽玛刀治疗原发性三叉神经痛(TN)的可行性、相关标准、疗效.方法 选择自1995年1月至2006年2月接受初次伽玛刀(GK1)治疗的277例TN患者.靶点选择三叉神经感觉根近桥脑处,中心剂量为70～80 Gy;对其中23例无效和15例复发者行第二次伽玛刀(GK2)治疗,中心剂最为65～80 Gy,50%等剂量线限定靶点,33例仍将三叉神经感觉根近桥脑处作为靶点,5例采用双靶点治疗.结果 (1)GK2治疗后疼痛缓解时间:GK2治疗后所有患者均得到满意的电话随访,随访时间为12～108个月(平均55个月),出现疼痛缓解时间为1～180 d(平均120d).(2)治疗有效率:GK1治疗后有效率为91.7%(254/277);GK2治疗后为84.2%(32/38),其中GK1治疗后23例无效者和15例复发者治疗有效率分别为73.9%(17/23)和100%(15/15),两组差异有统计学意义(P=0.045).(3)并发症:GK1治疗后发生面部麻木或麻痹30例(10.8%),GK2治疗后新发生8例,新并发症的发生率为21.1%.结论 伽玛刀是治疗TN安全有效的方法,严重副反应少.初次治疗后无效或复发者再次行伽玛刀治疗仍然有效,且复发者效果好于无效者.     

立体定向在卵圆孔定位射频毁损治疗三叉神经痛中的应用

目的探讨脑立体定向CT定位卵圆孔在射频毁损治疗三叉神经痛的应用。方法对155例原发三叉神经痛患者采用反戴立体定向仪CT定位对三叉神经半月节射频毁损术。结果 151例患者术后疼痛立即消失,有效率97.4%,并发症12例。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,降低了并发症的发生率。     

CT引导下三叉神经周围支射频热凝术联合阿霉素介入治疗原发性三叉神经痛

目的 探讨CT引导下三叉神经周围支射频热凝联合阿霉素介入治疗原发性三叉神经痛的疗效及安全性。方法 对2015年1月至2017年12月应用CT引导下三叉神经周围支射频术联合阿霉素介入治疗的103例原发性三叉神经痛的临床资料进行回顾性分析。采用视觉模拟量表（VAS）评分评估疼痛强度:０分,无痛;1~3分,轻度疼痛;4~6分,中度疼痛;7~10分,重度疼痛。以VAS评分降低作为疗效评价标准:优,降低≥75%;良,降低50%~74%;差,降低<50%。结果 103例中,疗效优97 例,良3例,差3例;优良率为97%。术后无严重并发症发生。结论 CT引导下三叉神经周围支射频术联合阿霉素介入治疗原发性三叉神经痛止痛效果好,安全性高。     

CT引导下温控射频热凝治疗三叉神经痛

目的探讨CT定位经皮穿刺卵圆孔的精确性与射频热凝治疗三叉神经痛的疗效评价。方法采用CT平行于中颅窝底的轴位及平行于穿刺针的冠状位薄层扫描，显示卵圆孔和穿刺针，确定二者的位置关系。结果共治疗三叉神经痛115例。随访3～36个月，平均6个月。恢复优良者95例（82．6％），良好20例（17.4％）。除面部有短时不同程度的感觉减退外，无其他严重、永久并发症。结论CT定位穿刺卵圆孔成功率高，解剖定位准确，操作安全，是一种微创治疗方法，具有较高临床实用价值。