Objective To observe the clinical effect of percutaneous radiofrequency ablation of the trigeminal ganglion in the treatment of primary trig
Objective To observe the clinical effect of percutaneous radiofrequency ablation of the trigeminal ganglion in the treatment of primary trigeminal neuralgia. Methods 192 cases of primary trigeminal neuralgia were treated with radiofrequency thermocoagulation and compared with other methods. Results the excellent and good rate was 94.8%, the effective rate was less than 0.5%. Conclusion the treatment of primary trigeminal neuralgia by percutaneous radiofrequency ablation of the semilunar ganglion is a safe, effective and less complication.
Key words trigeminal neuralgia semilunar ganglion radiofrequency thermocoagulation
Primary trigeminal neuralgia patients with severe subjective symptoms, severe pain. There are many kinds of theories, such as the theory of nerve degeneration and the theory of microvascular compression. In the treatment of trigeminal neuralgia, medicine, surgery, gamma knife, nerve block and lesion with different characteristics, including percutaneous semilunar ganglion radiofrequency surgery is safe, less side effect, less pain and other characteristics of more and more favored more specialist. The pain department of our hospital from 2005 to 2007, the use of percutaneous semilunar ganglion radiofrequency thermocoagulation of trigeminal neuralgia in the treatment of primary trigeminal neuralgia in 192 cases, is reported as follows.
1 materials and methods
1.1 the general data were male and female, with a mean age of 89 years (range, ranging from 38 to 83 years), with a mean age of 63.2 years. The course of disease ranged from 1 to 16 years, all of which were unilateral, including the left side in the left side, the right side in 87 cases, and the first one in the other 105 cases, all of which were of the second and Third branches of the mixed or mixed lesions in two cases. By the detailed examination of the patient, followed by CT or MRI, to exclude intracranial tumor pathological changes caused by trigeminal neuralgia, except two cases of "C Masi Bing" allergies, more than preoperative long-term use of C Masi Bing or phenytoin, pain control in patients under ideal or side effects of drugs is difficult to accept, of which three cases of recurrence underwent craniotomy after.
1.2 routine preoperative preparation. Using Swedish Eleketa company rf. The patient after entering the operation room, disinfection shop towels, after local anesthesia, in the C arm monitoring, choose the outside corner of the mouth 3 centimeters, the use of RF needle through the space between the front and the mandibular coracoid process of maxillary tuberosity, upward and backward, along the horizontal foramen ovale slow needle. The needle direction for articular tubercle ipsilateral pupil and face the same side of zygomatic root, about 5 ~ 6cm, the patient suddenly pain, which is consistent with the distribution of the trigeminal nerve, pull out the needle core, inserted into the RF electrodes for electrophysiological stimulation, when given 100Hz, 0.1 ~ 0.5V current stimulation, patients can feel the trigeminal pain, according to the reaction site properly adjust the direction and depth of puncture needle, the reaction site is consistent with the original pain site, the C arm and confirm the position of the needle tip, X-ray visible tip is located in the middle of foramen ovale, lateral visible tip located on the slopes of 0.5cm, combined with the stimulus with the reaction plane, such as the correct, slow intravenous diprivan, 3 ~ 6mg/kg, while paying close attention to patient circulation and oxygen saturation, the patient should not call or stop when the eyelash reflex disappeared note Medicine, began to control the temperature of radiofrequency coagulation damage, the general line of 4 hours of gradual increase in temperature of the radio frequency, temperature control at 60 to 90 DEG C, time in the 60 ~ 90 seconds. The range of nerve damage was measured and the corneal reflex and masticatory function were measured. Routine antibiotics were given to prevent local infection and swelling.
1.3 observation indexes were excellent: the pain disappeared completely; good: most of the pain was relieved; ineffective: no changes were observed. The observation time after second days after 6 to 12 months, an average of 8 months.
182 cases were excellent, the excellent rate was 94.8%, 8 cases of good, good rate of 4.1%, a case was recurred two times within six months, regarded as invalid (later confirmed mixed with glossopharyngeal neuralgia), invalid rate of 0.5%, a case of corneal ulcers, eye clinic referral cure.
In 1935, Kirschner D first using percutaneous semilunar ganglion radiofrequency ablation for the treatment of trigeminal neuralgia after 1974, Sweet and Wepsic of radiofrequency thermocoagulation in equipment and a series of technical improvements, the method widely used for doctors around the world, the current video thermal coagulation effect is significantly improved. The complications were significantly lower, become one of the main means for the treatment of trigeminal neuralgia [the 1].
Percutaneous radiofrequency ablation of the semilunar ganglion is the key to accurate puncture, in the C arm positioning can effectively adjust the direction of puncture, to avoid the optic nerve and intracranial arteriovenous injury. Compared with other treatments, it has obvious advantages:
3.1. and drug therapy for most patients taking long-term average Kamasi showed different degrees of side effects, including gastrointestinal reactions, dizziness, drowsiness, hallucinations, depression, rash, nystagmus, ataxia, leukopenia, including two of epidermolytic epispasis also frequently reported . And second-line drugs phenytoin, clonazepam, blood system, nervous system side effects for patients adversely.
Comparison of 3.2. with injection treatment: the choice of drugs for injection include anhydrous alcohol, glycerol, doxorubicin, etc.. Trigeminal ganglion after injection of chemical meningitis is relatively small error prone, tip can also cause abducent nerve paralysis, and infiltration of drugs in the trigeminal ganglion it is difficult to control, resulting in difference of the treatment effect have occurred.
Surgical treatment of 3.3. and surgical treatment of trigeminal neuralgia is including nerve peripheral branch avulsion amputation, skull nerve proximal resection, microvascular decompression, the treatment of trauma, and there are still some recurrence rate, so the patient compliance is poor, is not as the primary trigeminal neuralgia treatment of choice.
3.4. compared with radiotherapy stereotactic gamma knife treatment of trigeminal neuralgia and first appeared in 1971, there are certain advantages, no significant difference between the characteristics of the minimally invasive, safe and radiofrequency thermocoagulation, but the eye branch there is a higher rate with radiofrequency thermocoagulation.
3.5. and balloon compression intervention microcompression for interventional therapy under general endotracheal anesthesia during surgery, and patients unable to communicate, so the effective rate is only about 72% (3), compared with radiofrequency thermocoagulation difference.
In summary, percutaneous semilunar ganglion radiofrequency surgery for the treatment of trigeminal neuralgia and other traditional treatment methods have definite curative effect, small trauma, high safety, less complications, repeatability, has clinical value.
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