经皮穿刺半月神经节CT影像定位方法的比较分析

目的比较分析经皮穿刺半月神经节CT成像引导解剖定位方法。方法 16例三叉神经Ⅱ、Ⅲ支痛患者.按Hartel前入路法穿刺,行中颅窝底CT薄层扫描和三维成像重建,根据穿刺针和卵园孔在三维影像空间位置关系,调整穿刺针以到达要求的解剖定位,经射频电生理确认位置正确后,行三叉神经半月节的选择性热凝。综合分析扫描及后处理获取的CT定位像、CT分层扫描、多平面重建影像、CT三维重建影像对穿刺针在卵园孔解剖定位上的作用。结果 100%穿刺成功,一般1~2次调整即可进入卵园孔到达解剖深度,结合电生理定位可精确做到选择性的毁损。CT定位像能够间接定位和测量,但无法直观显示射频针和卵园孔的空间关系,CT分层扫描可以观察确定穿刺针在卵园孔的相对位置关系,间接推算深度,但不直观和立体,多平面重建后可计算穿刺针进入卵园孔的的大致深度,有良好的引导作用,可达到良好的解剖定位。CT三维重建后可准确测量穿刺针的深度和空间关系,直观立体,引导简捷,准确。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,可准确地把握穿刺针进入卵园孔的深度,以此可作为解剖定位,直观立体。综合利用CT扫描获取各类图像能起到更佳的引导定位作用。

Comparative analysis on CT image positioning of half ganglion during percutane ous picture

Objective To Comparative Analysis the methods of Anatomical localization of trigeminal ganglion percutaneous guided CT images in radiofrequency thermocoagulation for trigeminal neuralgia.Methods 16 cases of Ⅱ,Ⅲ-branch of trigeminal nerve pain patients were performed with Hartel method in anterior approach,then cranial fossa thin CT scan and three-dimensional imaging reconstruction.According to the spatial relationship in three-dimensional images,of the needle and oval foramen,the needle was adjusted to reach the anatomical position.After physiological correct position confirmed by the RF stimulation,selective thermal coagulation for trigeminal ganglion was done.The effect of CT image positioning was Comprehensive analyzed.Results 100% successful puncture,usually 1-2 times adjusted to enter the hole to reach the anatomical depth,combined with electrophysiological localization,the thermocoagulation can accurately be selective.The image Positioning as CT can indirectly locate and measure,but can not visualize the spatial relationship between RF Pinpoint and oval foramen;The layered CT scanning can be observed to determine the relative position of oval foramen and needle,indirect projection depth,but it was not intuitive,and three-dimensional;The image of CT multi-planar reconstruction can calculate the approximate depth of needle through oval foramen with a good guide,can achieve good anatomical position,the image of CT three-dimensional reconstruction can accurately measure the depth of the needle through oval foramen and the spatial relationships to oval foramen,guiding is simple 、accurate、 intuitive and three-dimensional.Conclusion Three-dimensional CT guided positioning foramen ovale,puncture increased the success rate and accuracy,this can be used as anatomical position in a intuitive three-dimensional fashion.Comprehensive utilization of various types of CT images can play a role in better positioning guide.