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...     

选择性射频热凝治疗三叉神经痛1936例临床分析与手术技巧

目的：总结1936例选择性射频热凝治疗的三叉神经痛病例的经验和体会，探讨三叉神经痛射频热凝治疗的方法和技巧。方法：分别进行眶上孔入路、眶下孔入路、侧入路或前入路卵圆孔射频热凝治疗。对Hartel前入路卵圆孔穿刺法进行改良。对45例半月神经节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1528例，良好336例，无疗效72例，总有效率96．3％。8个月～2年远期随访1097例，1年内复发122例，复发率为11．1％，2年内复发274例，复发率为24．9％，无严重并发症。结论：温控射频热凝治疗三叉神经痛疗效可靠，X线、三维CT及导航卵圆孔定位在一定程度上弥补了徒手穿刺的缺陷。     

射频热凝联合阿霉素治疗原发性三叉神经痛

目的:探讨射频热凝联合阿霉素治疗原发性三叉神经痛的安全性及临床疗效.方法150例三叉神经痛患者随机分成两组,RFT组(n=75):行单纯射频热凝术;RFT+A组(n=75):同RFT组方法行射频热凝后注射阿霉素3毫克.观察两种方法的疗效、复发率及副反应.结果:两种方法治疗三叉神经痛均获得良好的近期效果,RFT+A组副反应多于RFT组,RFT+A组远期复发率低于RFT组.结论:射频热凝联合阿霉素治疗原发性三叉神经痛远期效果优于单纯射频热凝术.阿霉素可暂时引起头痛、恶心、呕吐等不适.     

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。     

三叉神经痛的四重定位与射频治疗

目的：探讨四重定位下半月神经节射频温控热凝术治疗原发性三叉神经痛的疗效和安全性。方法：29例患者通过症状体征、解剖学、X线和电刺激准确定位后，在异丙酚全身麻醉下，行射频温控热凝治疗，温度分别设定为70℃、80℃、86℃共三次，每次持续时间均为60s。结果：29例患者穿刺成功率100％，术后疼痛即刻消失率100％，随访1～5个月无1例复发；并发角膜炎1例，并发症发生率3．4％。结论：异丙酚全麻下四重定位半月神经节射频温控热凝术治疗原发性三叉神经痛安全、准确、效佳，易于普及。     

半月节穿刺温控热凝射频术治疗顽固性三叉神经痛358例临床分析

目的：对采用半月节穿刺射频热凝术治疗358例顽固性三又神经痛病人临床资料进行分析，找出影响手术效果的因素及产生并发症的原因。方法：采用侧方入路或前侧入路穿刺半月节进行射频热凝术治疗，效果欠佳者加用眶下孔或颏孔射频治疗，对合并第肢痛的加用眶上孔射频治疗。结果：术后疗效优258例（占72％），良72例（占20％），无效28例（占8％），总有效率为92％。共285例随访3个月～5年。1年内复发16例（5．6％）；2年内复发25例（8．8％）；5年内复发29例（10．2％）。无严重并发症发生。结论：顽固性三又神经痛采用半月节穿刺温控射频治疗的效果满意，加用外周支组合治疗可提高疗效，该方法可进一步推广应用。     

椎间孔入路射频热凝术治疗腰椎间盘突出症临床疗效与突出物形态变化相关性研究

目的:探讨经椎间孔入路射频热凝术治疗腰椎间盘突出症临床疗效及其与突出物大小变化相关性.方法:329例腰椎间盘突出症(单间隙侧后型突出)行椎间盘靶点射频热凝术的患者,术后3月、6月、12月,采用日本骨科协会(JOA)下腰痛疾患疗效判定标准评定术后疗效,术后12月随访到的患者中随机抽取30例行腰椎间盘CT检查,采用椎间盘突出指数评定计算突出物大小,分析突出物大小变化率与JOA评分改善率相关关系.结果:所有患者术中、术后均未出现严重副作用.术后3月、6月、12月分别随访到329例、270例、224例患者,各时间点优良率分别分72.64%,69.26%,73.66%;三个时间点优良率比较X<'2>=1.125(p=0.57),各随访时间点优良率差异常无统计学意义.术后JOA评分改善率及突出物大小变化率Rs=0.092(P>0.05).结论:经椎间孔入路椎间盘靶点射频热凝术是治疗腰椎间盘突症的一种安全、有效方法,其临床疗效与突出物大小变化无明显相关关系.     

局麻下射频治疗三叉神经痛的心理分析及护理干预

目的分析原发性三叉神经痛在局麻下行射频热凝治疗患者术前术后的心理特点,为临床治疗和护理提供依据。方法通过对患者手术前、手术中、手术后进行护理干预,采用Zung焦虑自评量表SAS和Zung抑郁自评分量表SDS对125例三叉神经痛患者在手术前1—2d及手术后4～5d分别进行评定。结果患者手术后SAS较手术前有所下降（39．66±5．23 vs．31．79±4．87）,SDS较手术前有所下降（42．42±5．77vs．34．39±5．33）,差异有显著性。结论三叉神经痛患者存在明显的焦虑和抑郁心理,护理干预可降低和减轻病人的不良情绪,促进疾病的康复。     

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.     

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。     

Classic trigeminal neuralgia: a surgical perspective.

Classic trigeminal neuralgia (TN) was described as early as the first century AD, when treatments ranged from bloodletting to the application of poison-laden bandages. Current medical treatment utilizes a variety of drug therapies. Surgery is reserved for those who are unable to tolerate the side effects or in situations in which the drugs prove to be ineffective. Surgical options include microvascular decompression, percutaneous balloon compression, radio-frequency thermocoagulation, and glycerol injection. Nurses play a critical role in the multidisciplinary care of patients undergoing surgical procedures for TN.     

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。     

3D CT‐Guided Pulsed Radiofrequency Treatment for Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a pain syndrome characterized by pain in the trigeminal area often accompanied by a brief facial spasm or tic. The purpose of our study was to investigate the efficacy and clinical utility of CT‐guided pulsed radiofrequency (PRF) for treatment of TN. Patients who were diagnosed with severe TN between September 2010 and October 2010 at Beijing Tiantan Hospital were included. Pulsed radiofrequency treatment (PRFT) was employed to treat TN. To verify the accurate needle position, a thin‐section cranial CT scan was performed by using a multidetector CT scanner. Three‐dimensional reconstruction was performed to visualize the location of the needle and the foramen ovale. A total of 20 patients were included in the study. Seven patients (35%) had favorable outcome 1 year after the PRFT. The numeric rating scale in the 7 patients with good outcome was significantly lower than the 13 patients with bad outcome at 1 day, 1 week, and 2 weeks after the treatment. The remaining 13 patients had residual pain 2 weeks after the PRFT and had to receive radiofrequency thermocoagulation (RFTC). In conclusion, the results of our study demonstrate that CT‐guided PRFT is not an effective method of pain treatment for idiopathic TN as compared with conventional RFTC. However, CT‐guided PRFT is associated with less complication than RFTC.     

射频热凝腰脊神经后支治疗腰痛的临床研究

选择32例腰痛患者，均经物理治疗、中西药物治疗效果不佳．采用邵振海的腰痛神经定位法．经皮穿刺将射频针刺入损伤的腰脊神经后支处，射频热凝腰省神经后支．结果：32例患者中有27例取得明显的治疗效果．提示射频热凝腰省神经后支是治疗腰痛的一种有效方法。并对此种治疗方法的并发症、治疗机理及适应症的选择进行了探讨。     

CT引导下经皮腰椎间盘射频热凝术20例围术期护理体会

目的:探讨CT引导下经皮腰椎间盘射频热凝术治疗腰椎间盘突出症围术期的护理方法。方法:对20例腰椎间盘突出症患者于高分辨率十六层螺旋CT引导下,应用射频治疗仪经皮腰椎间盘突出射频热凝治疗,围术期给予精心护理。结果:治疗后3个月随访,临床治愈15例,显效5例,无效0例。结论:CT引导下经皮腰椎间盘射频热凝术治疗腰椎间盘突出症,具有穿刺准确,创伤小,患者痛苦小、康复快,疗效高,手术并发症少等优点,值得临床推广应用。     

Percutaneous procedures for trigeminal neuralgia: microcompression versus radiofrequency thermocoagulation. Personal experience

This paper reports the results achieved in the treatment of trigeminal neuralgia using two different percutaneous procedures: radiofrequency (RF) thermocoagulation (33 patients) and the new percutaneous microcompression (PMC; 74 patients) of the trigeminal ganglion. Acute pain relief was accomplished in 93.2% of the patients treated with PMC and in 81.8% of those treated with the RF method. Two years after the operation, neuralgia had recurred in 56% of the PMC patients and in 42.4% of the RF patients. The average recurrence time was 6.5 months after PMC and 18.5 months after RF. Side effects were essentially of 2 kinds: marked dysaesthesia that occurred after RF lesion in 24.2% and after PMC in 6.7% of the patients, and weakness of the masticatory muscles that was fairly common after PMC, although clinically relevant in only 1 case. The procedure has the benefit of simplicity and fewer side effects. The results obtained by using different compression times in different patients indicates that the most suitable compression time is between 4 and 6 min. When pain recurred the procedure was repeated unless the pain was in the third division, in which case an RF lesion was made. If the pain recurred a second time, RF lesions were made if the pain was in the second or third division.     

三维CT导向卵圆孔精确定位射频热凝治疗三叉神经痛研究

目的:探讨三维CT引导卵圆孔定位在三叉神经痛射频热凝治疗中的应用。方法:对20例三叉神经痛病人,取仰卧位,采用Hartel前入路穿刺法,应用三维CT引导以明确卵圆孔位置,并调整穿刺针的方向和深度,穿刺卵圆孔定位成功后,行温控射频热凝治疗。结果:穿刺针均位于卵圆孔内,治疗后疼痛即刻缓解,无严重并发症发生。结论:三维CT引导卵圆孔定位,提高了卵圆孔穿刺的成功率和精确性,弥补了徒手穿刺的缺陷,增加了操作的安全性,降低并发症发生,可供临床推广应用。     

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.     

Peripheral and gasserian ganglion-level procedures for the treatment of trigeminal neuralgia.

This review discusses the various peripheral and ganglion-level procedures available for treating trigeminal neuralgia and summarizes specific success and complication rates for each technique. METHOD: A review of the available literature. RESULTS: It appears that expertly performed ganglion-level procedures (radiofrequency thermocoagulation, balloon compression, and glycerolysis) are more effective than peripheral procedures but neither approach can be relied on to produce long-term pain relief. All of these procedures are neurodestructive and can cause sensory loss and dysesthesia. Effective drug therapy may not be acceptable to some patients as adverse cognitive side effects are increasingly recognized. CONCLUSIONS: Each patient should receive an informed and impartial account of the available surgical options. There is a need for prospective randomized controlled studies in procedure-na?ve subjects to determine the optimal surgical management of trigeminal neuralgia.     

Choice of open or percutaneous procedures in the surgical treatment of trigeminal neuralgia

The aim of this study was to define criteria for the selection of patients for percutaneous or open operations for the cure of drug-resistant trigeminal neuralgia (TN). Trigeminal percutaneous radiofrequency thermorhizotomy (TPRT) has an established place because of its safety in elderly patients, while microvascular decompression (MVD) has appeal in younger patients beause of its non-destructive nature and because it attacks what is believed to be the primary etiology of tic douloureux. Nevertheless, MVD is a successful operation only when true neurovascular conflict (NVC) is ascertained, rather than a simple arterial loop and neurovascular contract. Probably, many immediate failures and early relapses are the consequence of the inadequate patient selection for MVD on the presumption that this operation is in any case the ideal cure. The inadequate selection can be explained by the difficult preoperative diagnosis of NVC in the past. Indeed, angiography and computed tomography showed the neurovascular contact but not the size of compression. Fortunately, today magnetic resonance imaging is a reliable instrument to ascertain NVC. So, the diatribe between the supporters of percutaneous techniques and MVD can be concluded with the following: (1) percutaenous techniques are indicated for patients without demonstrated NVC (including patients with TN in multiple sclerosis) and in those with NVC if MVD is contraindicated by ill-health or refused by the informed patient; and (2) MVD is incated for patients with ascertained NVC who are in good health and who, informed of the surgical risk, favor this operation desiring no sensory deficit. Received: 23 June 2001 / Accepted in revised form: 24 August 2001