3D打印导航模板在圆孔外口三叉神经第二支射频治疗中的应用
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摘要
目的评估3D打印导航模板在圆孔入路三叉神经第二支射频热凝治疗中的有效性和准确性。方法选择原发性三叉神经第二支疼痛患者43例,男27例,女16例,年龄45~85岁,ASAⅠ或Ⅱ级,按照随机数字表法分为观察组(A组,n=21)和对照组(B组,n=22)。所有患者术前均行头颅CT三维重建,模拟穿刺并确定最佳穿刺方案。A组采用3D打印导板辅助经皮穿刺,B组在CT引导下常规穿刺,术中均经3D-CT影像及电刺激试验确认针尖位置后再行射频热凝治疗。记录患者一次穿刺成功例数、术中CT扫描次数、术中CT辐射量、手术时间、术后即刻疼痛NRS评分以及感觉减退、面部肿胀、角膜反射减弱、脑脊液漏等并发症发生情况。结果 A组一次性穿刺成功率明显高于B组(90.4%vs.22.7%),CT扫描次数明显少于B组[(1.1±0.3)次vs.(2.8±1.3)次],CT辐射量明显小于B组[(323.1±108.7)mGy*cm vs.(787.8±355.7)mGy*cm],手术时间明显短于B组[(15.3±5.5)min vs.(28.5±6.5)min](P<0.05)。与术前比较,术后两组患者NRS评分明显降低[A组:(3.1±1.7)分vs.(8.5±0.7)分;B组:(3.1±1.5)分vs.(8.5±0.7)分](P<0.05);两组患者NRS评分组间差异无统计学意义。所有患者均未发生严重并发症。结论在充分术前路径规划的基础上,3D打印导航模板能够明显提高圆孔穿刺精准性、安全性,提高三叉神经第二支射频治疗的效率与质量。
Objective To explore the effectiveness and precision of 3D printing navigational template in puncturing of foramen rotundum for radiofrequency thermocoagulation to treat primary trigeminal neuralgia(V2).Methods Forty-three patients(27 males,16 females,aged 45-85 years,ASA gradeⅠ orⅡ)with primary trigeminal neuralgia(V2)were included and randomly divided into experimental group(group A,n=21)and control group(group B,n=22).After taking a CT scan and 3D reconstruction of each patient's skull,puncture simulations were carried out,then the final puncture schemes were decided.In group A,puncture was performed under guidance of navigational template but was conducted empirically in group B.In both groups,3D-CT image and electrical stimulation were used in all the procedures to confirm the location of point of needle before radiofrequency thermocoagulation.The cases of successful puncture in one-time,times of CT scanning,radiant quantity,operation time during the operation in both groups were recorded.Furthermore,NRS scores and complications including hypoesthesia,motor function degeneration,hematoma,absence of corneal reflex,cerebrospinal fluid leakage were recorded after procedure.Results The rate of successful puncture in one-time of group A was superior than that of group B(90.4% vs.22.7%).Compared with group B,CT scan times [(1.1±0.3)times vs.(2.8±1.3)times],radiant quantity [(323.1±108.7)mGy*cm vs.(787.8±355.7)mGy*cm],operation time[(15.3±5.5)min vs.(28.5±6.5)min]in group A were significantly reduced(P<0.05).NRS scores of both two groups were obviously reduced after surgery[group A:(3.1±1.7)scores vs.(8.5±0.7)scores;group B:(3.1±1.5)scores vs.(8.5±0.7)scores](P<0.05),but the effectiveness in group A was not superior than group B.No serious complications occurred in all patients.Conclusion On the basis of sufficient preoperative planning of puncture approach,3Dprinting template can significantly enhance the effectiveness and precision of puncture of foramen rotundum,improving the efficiency and quality of radiofrequency treatment of primary trigeminal neuralgia(V2).
Objective To explore the effectiveness and precision of 3D printing navigational template in puncturing of foramen rotundum for radiofrequency thermocoagulation to treat primary trigeminal neuralgia(V2).Methods Forty-three patients(27 males,16 females,aged 45-85 years,ASA gradeⅠ orⅡ)with primary trigeminal neuralgia(V2)were included and randomly divided into experimental group(group A,n=21)and control group(group B,n=22).After taking a CT scan and 3D reconstruction of each patient's skull,puncture simulations were carried out,then the final puncture schemes were decided.In group A,puncture was performed under guidance of navigational template but was conducted empirically in group B.In both groups,3D-CT image and electrical stimulation were used in all the procedures to confirm the location of point of needle before radiofrequency thermocoagulation.The cases of successful puncture in one-time,times of CT scanning,radiant quantity,operation time during the operation in both groups were recorded.Furthermore,NRS scores and complications including hypoesthesia,motor function degeneration,hematoma,absence of corneal reflex,cerebrospinal fluid leakage were recorded after procedure.Results The rate of successful puncture in one-time of group A was superior than that of group B(90.4% vs.22.7%).Compared with group B,CT scan times [(1.1±0.3)times vs.(2.8±1.3)times],radiant quantity [(323.1±108.7)mGy*cm vs.(787.8±355.7)mGy*cm],operation time[(15.3±5.5)min vs.(28.5±6.5)min]in group A were significantly reduced(P<0.05).NRS scores of both two groups were obviously reduced after surgery[group A:(3.1±1.7)scores vs.(8.5±0.7)scores;group B:(3.1±1.5)scores vs.(8.5±0.7)scores](P<0.05),but the effectiveness in group A was not superior than group B.No serious complications occurred in all patients.Conclusion On the basis of sufficient preoperative planning of puncture approach,3Dprinting template can significantly enhance the effectiveness and precision of puncture of foramen rotundum,improving the efficiency and quality of radiofrequency treatment of primary trigeminal neuralgia(V2).
引文
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[7]陆丽娟,韩影,槐洪波,等.3D打印经皮穿刺导航系统在半月神经节射频热凝术中的应用.中国疼痛医学杂志,2015,21(12):914-918.
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[10]Yang Y,Shao Y,Wang H,et al.Neuronavigation-assisted percutaneous radiofrequency thermocoagulation therapy in trigeminal neuralgia.Clin J Pain,2007,23(2):159-164.
[11]Koizuka S,Saito S,Kubo K,et al.Percutaneous radio-frequency mandibular nerve rhizotomy guided by CT fluoroscopy.AJNR Am J Neuroradiol,2006,27(8):1647-1648.
[12]Li X,Ni J,Yang L,et al.A prospective study of Gasserian ganglion pulsed radiofrequency combined with continuous radiofrequency for the treatment of trigeminal neuralgia.J Clin Neurosci,2012,19(6):824-828.
[13]Wang JY,Bender MT,Bettegowda Ch.Percutaneous Procedures for the Treatment of Trigeminal Neuralgia.Neurosurg Clin N Am,2016,27(3):277-295.
[14]韩兴军,杜英林,肖建国,等.三叉神经根、Meckel腔内半月神经节及其分支与断层标本对比的解剖学研究.医学影像学杂志,2008,18(7):712-716.
[15]Zhang WC,Zhong WX,Li ST,et al.Neuronavigator-guided percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia.Ir J Med Sci,2012,181(1):7-13.
[16]Xue T,Yang W,Guo Y,et al.3D image-guided percutaneous radiofrequency thermocoagulation of the maxillary branch of the trigeminal nerve through foramen rotundum for the treatment of trigeminal neuralgia.Medicine(Baltimore),2015,94(45):e1954.
[17]Yang JT,Lin M,Lee MH,et al.Percutaneous trigeminal nerve radiofrequency rhizotomy guided by computerized tomography with three-dimensional image reconstruction.Chang Gung Med J,2010,33(6):679-683.
[2]Sweet WH,Wepsic JG.Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers.J Neurosurg,1974,40(2):143-156.
[3]Kanpolat Y,Savas A,Bekar A,et al.Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia:25-year experience with 1,600patients.Neurosurgery,2001,48(3):524-534.
[4]Huang B,Yao M,Feng Z,et al.CT-guided percutaneous infrazygomatic radiofrequency neurolysis through foramen rotundum to treat V2trigeminal neuralgia.Pain Med,2014,15(8):1418-1428.
[5]李顺,廖丽君,胡馨,等.薄层CT引导下经皮穿刺圆孔外口射频热凝治疗三叉神经痛.中华神经外科杂志,2013,29(3):284-286.
[6]陶高见,林建,朱彤.CT引导下经眶——圆孔入路射频热凝治疗第2支三叉神经痛.中国疼痛医学杂志,2012,18(5):264-268.
[7]陆丽娟,韩影,槐洪波,等.3D打印经皮穿刺导航系统在半月神经节射频热凝术中的应用.中国疼痛医学杂志,2015,21(12):914-918.
[8]韩影,王然,陆丽娟.3D重建在三叉神经第二支射频治疗穿刺路径选择中的应用.中国疼痛医学杂志,2016,22(12):903-907.
[9]Stepien A.New international classification of headache disorders by the International Headache Society.Neurol Neurochir Pol,2004,38(4):255-256.
[10]Yang Y,Shao Y,Wang H,et al.Neuronavigation-assisted percutaneous radiofrequency thermocoagulation therapy in trigeminal neuralgia.Clin J Pain,2007,23(2):159-164.
[11]Koizuka S,Saito S,Kubo K,et al.Percutaneous radio-frequency mandibular nerve rhizotomy guided by CT fluoroscopy.AJNR Am J Neuroradiol,2006,27(8):1647-1648.
[12]Li X,Ni J,Yang L,et al.A prospective study of Gasserian ganglion pulsed radiofrequency combined with continuous radiofrequency for the treatment of trigeminal neuralgia.J Clin Neurosci,2012,19(6):824-828.
[13]Wang JY,Bender MT,Bettegowda Ch.Percutaneous Procedures for the Treatment of Trigeminal Neuralgia.Neurosurg Clin N Am,2016,27(3):277-295.
[14]韩兴军,杜英林,肖建国,等.三叉神经根、Meckel腔内半月神经节及其分支与断层标本对比的解剖学研究.医学影像学杂志,2008,18(7):712-716.
[15]Zhang WC,Zhong WX,Li ST,et al.Neuronavigator-guided percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia.Ir J Med Sci,2012,181(1):7-13.
[16]Xue T,Yang W,Guo Y,et al.3D image-guided percutaneous radiofrequency thermocoagulation of the maxillary branch of the trigeminal nerve through foramen rotundum for the treatment of trigeminal neuralgia.Medicine(Baltimore),2015,94(45):e1954.
[17]Yang JT,Lin M,Lee MH,et al.Percutaneous trigeminal nerve radiofrequency rhizotomy guided by computerized tomography with three-dimensional image reconstruction.Chang Gung Med J,2010,33(6):679-683.