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目的探讨CT引导下半月节射频热凝治疗顽固性三叉神经痛的疗效。方法 2007年3月～2010年12月,在CT引导下对68例常规口服药物治疗无效的三叉神经痛进行经皮穿刺半月节射频热凝治疗,三叉神经第Ⅰ支9例,第Ⅱ支12例,第Ⅲ支17例,第Ⅰ+Ⅱ支3例,第Ⅱ+Ⅲ支24例,第Ⅰ+Ⅱ+Ⅲ支3例。结果 68例均于CT引导下穿刺进入相应卵圆孔。66例治疗后疼痛消失,1例减轻,1例无效。68例随访3～48个月,平均31个月,5例复发,复发率7.4%。1例三叉神经第Ⅰ支射频术后同侧眼球结膜充血,2周后角膜溃疡,8周后溃疡穿孔,10周后穿孔自行愈合,但该眼视力丧失。结论 CT引导下半月节射频热凝能有效治疗顽固性三叉神经痛。对于三叉神经第Ⅰ支的射频治疗,一定要控制热凝温度于70℃以下,严密监测射频过程中患者的角膜反射,做到角膜反射迟钝即结束治疗。
Objective To investigate the curative effect of CT-guided radiofrequency thermocoagulation in the treatment of refractory trigeminal neuralgia. Methods From March 2007 to December 2010, 68 cases of trigeminal neuralgia with conventional oral medication were treated by percutaneous transhepatic radiofrequency thermocoagulation under the guidance of CT. There were 9 cases of the first trigeminal nerve, the second 12 Cases, the first branch of 17 cases, Ⅰ + Ⅱ branch in 3 cases, Ⅱ + Ⅲ branch in 24 cases, Ⅰ + Ⅱ + Ⅲ branch in 3 cases. Results 68 cases were punctured under the guidance of CT into the corresponding foramen ovale. 66 cases of pain disappeared after treatment, 1 case alleviated, 1 case is invalid. 68 cases were followed up for 3 ~ 48 months, an average of 31 months, 5 cases of recurrence, the recurrence rate was 7.4%. One case of ipsilateral trigeminal nerve radiofrequency ipsilateral eye conjunctival hyperemia, corneal ulcer after 2 weeks, 8 weeks after ulcer perforation, 10 weeks after perforation to heal, but the loss of visual acuity. Conclusion CT-guided radiofrequency thermocoagulation in the second half of the month can effectively treat refractory trigeminal neuralgia. Radiofrequency treatment of the first branch of the trigeminal nerve, we must control the thermal coagulation temperature below 70 ℃, close monitoring of patients with corneal reflex during the RF process, so that the corneal refractive delay is the end of treatment.