CT引导下半月神经节射频热凝术治疗三叉神经痛

三叉神经痛系三叉神经分布区内反复发作阵发性剧痛的一种疾病，原因不明，也可继发于其他疾病。是常见的疼痛性疾病，严重影响患者的生活质量。该病的诊断容易，治疗较困难。一般的患者可以采用口服药物治疗，药物治疗无效的重度患者可选择半月神经节化学毁损术、射频热凝毁损术和微球囊压迫术。其中，半月神经节射频热凝术的创伤较轻，疗效确切。但由于卵圆孔位置较深，解剖变异较大，     

三维CT引导卵圆孔定位射频热凝治疗三叉神经痛的护理

对20例三又神经痛患者采用三维CT重建引导卵圆孔精确定位射频热凝治疗。结果经治疗后，疼痛立即消失19例．疼痛减轻1例，有效率100％。术后电话随访3～12个月，无感染等并发症发生，面部疼痛复发1例，经再次给予射频热凝毁损后疼痛消失。提出术前加强心理护理与健康教育，做好环境、设备准备；术中严格无菌操作，密切配合；术后密切观察患者体征，严格警惕颅内感染发生的征象，做好眼部、口腔、皮肤护理及健康教育，可降低并发症发生率，促进患者早日康复。     

CT引导下射频热凝术治疗三叉神经痛的疗效观察

目的:观察CT引导下行射频热凝治疗三叉神经痛的160例患者的疗效.方法:将160例确诊为三叉神经痛患者随机分为对照组与观察组各80例,对照组行药物治疗,观察组采用射频热凝三叉神经痛治疗,评估两组疗效、治疗前后视觉模拟评分(VAS).结果:观察组患者治疗后VAS下降,差异有统计学意义(P＜0.05),并且观察组VAS评分较对照组明显(P＜0.05).结论:射频热凝术治疗三叉神经痛疗效确切,是一种有效的治疗方法,值得临床应用推广.     

CT引导下射频热凝术治疗原发性三叉神经痛的疗效观察

目的:探讨CT引导下行射频热凝治疗原发性三叉神经痛的临床效果.方法:将184例原发性三叉神经痛的患者在CT引导下行射频热凝治疗结果,副作用及并发症进行比较,结论:CT引导下行射频热凝治疗原发性三叉神经痛具有疗效好,安全性高,副作用少等优点,值得推广.     

射频热凝治疗三叉神经痛并发症分析

本院自2000年1月至2003年1月共收治三叉神经痛、用射频热凝治疗53例,效果满意,也出现了一些并发症.现结合文献,作一些探讨.     

神经导航及三维CT重建联合定位下射频热凝治疗三叉神经痛18例临床分析

目的 探讨神经导航系统及螺旋CT三维重建卵圆孔定位在三叉神经痛射频热凝治疗中的临床应用. 方法 18例三叉神经痛病人术前均行螺旋CT薄层扫描,将影像学资料输入神经导航系统,标记卵圆孔等重要结构,术中在导航实时引导下进行卵圆孔穿刺,进一步在螺旋CT三维重建下调整毁损针位置,然后行射频热凝治疗. 结果 术中卵圆孔穿刺准确率100％,术后即刻疗效优良15例,好转3例,无角膜麻痹、颅内血肿及死亡病例等严重并发症. 结论 在三叉神经痛的射频热凝治疗中,应用神经导航及螺旋CT三维重建提高了穿刺卵圆孔的精确率,减少了手术并发症.     

C臂机引导下经皮穿刺半月神经节射频温控热凝毁损术治疗三叉神经痛

目的总结在C臂机引导下经皮穿刺卵圆孔三叉神经半月神经节热凝治疗三叉神经痛78例的穿刺方法和效果。方法选择三叉神经痛第II、III支患者78例,在C臂机引导下经前入路卵圆孔穿刺半月神经节,术中验证电极到达半月神经节后,对半月神经节行射频温控热凝毁损治疗。结果术后即刻显效,优63例(80.8%),良13例(16.7%),无效者2例(2.6%),总有效率97.4%(76/78)。无脑脊液漏等严重并发症发生。术后随访6个月~2 a,76例治疗效果优良的患者未见复发。结论在C臂机引导下经皮穿刺卵圆孔三叉神经半月神经节射频温控热凝毁损治疗三叉神经痛,成功率高、效果好,并发症少,复发率低、安全。     

三维CT引导卵圆孔定位射频热凝治疗三叉神经痛的护理

对20例三叉神经痛患者采用三维CT重建引导卵圆孔精确定位射频热凝治疗.结果 经治疗后,疼痛立即消失19例,疼痛减轻1例,有效率100%.术后电话随访3～12个月.无感染等并发症发生,面部疼痛复发1例,经再次给予射频热凝毁损后疼痛消失.提出术前加强心理护理与健康教育,做好环境、设备准备;术中严格无菌操作,密切配合;术后密切观察患者体征,严格警惕颅内感染发生的征象,做好眼部、口腔、皮肤护理及健康教育,可降低并发症发生率,促进患者早日康复.     

CT定位选择性射频热凝术治疗原发性三叉神经痛

目的探讨CT定位选择性三叉神经半月节射频热凝术治疗原发性三叉神经痛的临床价值。方法选择24例原发性三叉神经痛，Hartel前入路穿刺法，局麻CT定位下经卵圆孔穿刺三叉神经半月节，经电生理验证后温控射频热凝对靶点进行选择性毁损治疗。结果疼痛消失18例，疼痛减轻5例，无缓解1例，总有效率95、8％（23／24）。24例随访3～18个月，平均12个月。2例（8、3％）复发。结论CT定位选择性三叉神经半月节射频热凝术治疗原发性三叉神经痛安全简便，疗效可靠，并发症少，尤其适用于高龄或不能耐受开颅手术的病人。     

内窥镜配合显微镜微血管减压治疗三叉神经痛

目的总结采用内窥镜配合显微镜微血管减压术治疗三叉神经痛的临床治疗经验。方法 2008年3月～2011年3月,采用内窥镜配合显微镜微血管减压术治疗三叉神经痛41例。在显微镜下探查三叉神经整个脑池段全程,再以内窥镜观察三叉神经脑干端和Meckel腔内口处,显露压迫或接触神经根的动脉襻或静脉,静脉电凝后切断,动脉襻采用Teflon棉垫隔开。结果术中发现单纯动脉压迫29例,单纯静脉压迫6例,动静脉联合压迫6例。小脑上动脉25例,小脑前下动脉5例,小脑后下动脉3例,基底动脉2例,扭曲、冗长的椎动脉2例,其中2例为2根动脉压迫;岩静脉分支12例。术后疼痛立即消失34例,疼痛延迟缓解5例（术后2周4例,术后1个月1例）,疼痛无明显减轻2例。手术有效率95.1%（39/41）。术后轻度面瘫伴耳鸣1例,面部麻木1例,3周内症状均消失。39例有效者随访6个月～3年,平均21.4月,其中〉12个月31例,无复发。结论微血管减压术是治疗三叉神经痛的有效方法,内窥镜配合显微镜技术可有效降低术后并发症,减少创伤,避免遗漏责任血管。     

Percutaneous Controlled Radiofrequency Rhizotomy in the Management of Patients with Trigeminal Neuralgia due to Multiple Sclerosis

Summary  Between the years 1974 and 1999, 1,672 patients with medically intractable trigeminal neuralgia (TN) were treated by percutaneous controlled radiofrequency (RF) rhizotomy by the senior author and co-workers at the Department of Neurosurgery, Ankara University School of Medicine. Sixteen hundred cases (95.7%) were found to have idiopathic TN, while 72 cases (4.3%) were classified as symptomatic. In the latter group, TN was found to be caused by multiple sclerosis (MS) in 17 cases (23.6%), one of whom had bilateral TN. All patients having TN with MS (17 cases) underwent percutaneous controlled radiofrequency rhizotomy (25 procedures) as the procedure of choice. The MS patients were followed for an average of 60 months (range: 6–141 months). Complete pain relief was achieved with a single procedure in 12 of the 17 MS cases (70.6%). Early (less than 2 weeks) pain recurrence was seen in two patients (11.8%), while the overall recurrence rate was 29.4%. A second procedure was required to control TN in three cases (17.6%), a third in one (5.9%), and twice for each side for the case with bilateral TN (5.9%). Pain was completely relieved in 14 cases (82.4%) with single or multiple RF rhizotomies. In three cases (17.6%), partial pain control was achieved with RF rhizotomy, and the patients continued to receive adjunctive medical therapy. No complications were observed. All 17 patients (100%) were classified to have done well with RF rhizotomy.  Satisfactory results and good long-term pain control were obtained in patients having TN due to MS with percutaneous controlled RF rhizotomy. The authors propose that RF rhizotomy may be a safe and effective procedure in the neurosurgical armamentarium for the treatment of patients having TN due to MS.     

Pure V1 Trigeminal Neuralgia Caused by a Cryptic Trigeminal Neurinoma

Summary  Most idiopathic trigeminal neuralgias are caused by vascular compression at the root entry zone of the trigeminal nerve. (Dandy [1] and Jannetta [2]) We report a case of pure V1 trigeminal neuralgia caused by a small trigeminal neurinoma which had not been detected on preoperative neuroradiological examination.