计算机辅助设计与解剖定位在卵圆孔穿刺规划中的对比研究
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摘要
目的研究利用计算机辅助设计技术(computer-assisted design, CAD)规划三叉神经毁损术卵圆孔穿刺路径与解剖定位法在穿刺参数方面的差异,提出解剖定位法的优化方案。方法选择2014年1月至2017年6月接受3D导航模板引导下半月神经节射频热凝术的原发性三叉神经痛患者57例,男22例,女35例。回顾分析每例患者的穿刺方案(CAD法),并与模拟的传统前入路定位方案(解剖定位法,取口角外2.5 cm作为进针点)进行对比分析,观察穿刺路径被遮挡情况。结果与传统解剖定位法比较,基于三维影像的CAD路径规划明显降低穿刺路径被遮挡率(P<0.05),该方法在穿刺方向上的可获得卵圆孔面积及短径明显大于传统解剖定位法(P<0.05)。91.2%患者通过CAD三维影像法规划的进针点分布在口角外2.5 cm进针点的内下方。结论将传统解剖定位法进针点向内下方调整,可以减少穿刺过程遮挡,获得一定的针道调整空间,有助于提高穿刺成功率。
Objective To compare the difference of puncturing parameters between computer-assisted design(CAD) technique and anatomical landmarks in foramen ovale puncture and to propose optimized procedure using anatomical landmarks. Methods From January 2014 to June 2017, 57 patients 22 males and 35 females, were diagnosed with primary trigeminal neuralgia and treated with CAD template guided radiofrequency thermocoagulation therapy through foramen ovale(FO). We retrospectively analyzed the surgical plan with CAD method and simulated the traditional method of preoperative plan for each patient. The rate of the trajectory obstruction, available area and short diameter of FO in the direction of puncture were measured and compared between the two methods. Relative locations of percutaneous insertion points were measured. Results Compared with the traditional method, CAD method significantly reduced the rate of trajectory obstruction(P < 0.05). Besides, available area and short diameter of FO in the direction of puncture were significantly greater in CAD method(P < 0.05). Compared with traditional method(2.5 cm lateral the oral angle), 91.2% of the insertion points in CAD method were distributed in the lower inner quadrant. Conclusion Adjustment of the traditional insertion point to the lower inner part could reduce the occlusion of the cannulation, gain more space for puncture, hence it improvs the success rate of puncture.
Objective To compare the difference of puncturing parameters between computer-assisted design(CAD) technique and anatomical landmarks in foramen ovale puncture and to propose optimized procedure using anatomical landmarks. Methods From January 2014 to June 2017, 57 patients 22 males and 35 females, were diagnosed with primary trigeminal neuralgia and treated with CAD template guided radiofrequency thermocoagulation therapy through foramen ovale(FO). We retrospectively analyzed the surgical plan with CAD method and simulated the traditional method of preoperative plan for each patient. The rate of the trajectory obstruction, available area and short diameter of FO in the direction of puncture were measured and compared between the two methods. Relative locations of percutaneous insertion points were measured. Results Compared with the traditional method, CAD method significantly reduced the rate of trajectory obstruction(P < 0.05). Besides, available area and short diameter of FO in the direction of puncture were significantly greater in CAD method(P < 0.05). Compared with traditional method(2.5 cm lateral the oral angle), 91.2% of the insertion points in CAD method were distributed in the lower inner quadrant. Conclusion Adjustment of the traditional insertion point to the lower inner part could reduce the occlusion of the cannulation, gain more space for puncture, hence it improvs the success rate of puncture.
引文
[1] Fraioli MF,Cristino B,Moschettoni L,et al.Validity of percutaneous controlled radiofrequency thermocoagulation in the treatment of isolated third division trigeminal neuralgia.Surg Neurol,2009,71(2):180-183.
[2] Cheng JS,Lim DA,Chang EF,et al.A review of percutaneous treatments for trigeminal neuralgia.Neurosurgery,2014,10 Suppl 1:25-33.
[3] Guo Z,Wu B,Du C,et al.Stereotactic approach combined with 3D CT reconstruction for difficult-to-access foramen ovale on radiofrequency thermocoagulation of the gasserian ganglion for trigeminal neuralgia.Pain Med,2016,17(9):1704-1716.
[4] Zdilla MJ,Hatfield SA,McLean KA,et al.Orientation of the foramen ovale:an anatomic study with neurosurgical considerations.J Craniofac Surg,2016,27(1):234-237.
[5] Tubbs RS,May WR Jr,Apaydin N,et al.Ossification of ligaments near the foramen ovale:an anatomic study with potential clinical significance regarding transcutaneous approaches to the skull base.Neurosurgery,2009,65(suppl 6):60-64.
[6] Aydoseli A,Akcakaya MO,Aras Y,et al.Neuronavigation-assisted percutaneous balloon compression for the treatment of trigeminal neuralgia:The technique and short-term clinical results.Br J Neurosurg,2015,29(4):552-558.
[7] Tronnier VM,Rasche D,Hamer J,et al.Treatment of idiopathic trigeminal neuralgia:comparison of long—term outcome after radiofrequency rhizotomy and microvascular decompression.Neumsurgery,2001,48(6):1261-1267.
[8] 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.
[9] 黄华.颅骨卵圆孔的形态观察及应用解剖.北方药学,2012,9(8):61-62.
[10] 何玉泉,沈云霞,张祥华,等.国人颅骨卵圆孔解剖特点与卵圆孔穿刺关系的研究.医学影像学杂志,2004,14(12):978-979.
[11] Georgiopoulos M,Ellul J,Chroni E,et al.Minimizing technical failure of percutaneous balloon compression for trigeminal neuralgia using neuro-navigation.ISRN Neurol,2014,2014:630418.
[12] Bale RJ,Laimer I,Martin A,et al.Frameless stereotactic cannulation of the foramen ovale for ablative treatment of trigeminal neuralgia.Neurosurgery,2006,59(4 Suppl 2):ONS394-401.
[13] Ding W,Chen S,Wang R,et al.Percutaneous radiofrequencythermocoagulation for trigeminal neuralgia using neuronavigation-guided puncture from a mandibular angle.Medicine (Baltimore),2016,95(40):e4940.
[14] 乔梁,朱宏伟,陶蔚,等.神经导航引导下三叉神经半月节射频热凝术电生理及疗效研究.中国疼痛医学杂志,2015,21(11):862-864.
[15] 徐振宇,王佩珊,杨欣艳.国人颅骨卵圆孔的观测及其应用解剖的研究.黑龙江医药科学,2011,34(4):112.
[16] 张环,程敏,郭志刚,等.应用3D CT三维重建方法观察颅底翼突外侧板遮挡卵圆孔的情况.中国实验诊断学,2018,22(4):688-689.
[17] 程敏,王涵,李朝辉,等.颅底3D-CT重建测量卵圆孔在三叉神经射频热凝术中的作用.中国实验诊断学,2018,22(2):197-199.
[2] Cheng JS,Lim DA,Chang EF,et al.A review of percutaneous treatments for trigeminal neuralgia.Neurosurgery,2014,10 Suppl 1:25-33.
[3] Guo Z,Wu B,Du C,et al.Stereotactic approach combined with 3D CT reconstruction for difficult-to-access foramen ovale on radiofrequency thermocoagulation of the gasserian ganglion for trigeminal neuralgia.Pain Med,2016,17(9):1704-1716.
[4] Zdilla MJ,Hatfield SA,McLean KA,et al.Orientation of the foramen ovale:an anatomic study with neurosurgical considerations.J Craniofac Surg,2016,27(1):234-237.
[5] Tubbs RS,May WR Jr,Apaydin N,et al.Ossification of ligaments near the foramen ovale:an anatomic study with potential clinical significance regarding transcutaneous approaches to the skull base.Neurosurgery,2009,65(suppl 6):60-64.
[6] Aydoseli A,Akcakaya MO,Aras Y,et al.Neuronavigation-assisted percutaneous balloon compression for the treatment of trigeminal neuralgia:The technique and short-term clinical results.Br J Neurosurg,2015,29(4):552-558.
[7] Tronnier VM,Rasche D,Hamer J,et al.Treatment of idiopathic trigeminal neuralgia:comparison of long—term outcome after radiofrequency rhizotomy and microvascular decompression.Neumsurgery,2001,48(6):1261-1267.
[8] 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.
[9] 黄华.颅骨卵圆孔的形态观察及应用解剖.北方药学,2012,9(8):61-62.
[10] 何玉泉,沈云霞,张祥华,等.国人颅骨卵圆孔解剖特点与卵圆孔穿刺关系的研究.医学影像学杂志,2004,14(12):978-979.
[11] Georgiopoulos M,Ellul J,Chroni E,et al.Minimizing technical failure of percutaneous balloon compression for trigeminal neuralgia using neuro-navigation.ISRN Neurol,2014,2014:630418.
[12] Bale RJ,Laimer I,Martin A,et al.Frameless stereotactic cannulation of the foramen ovale for ablative treatment of trigeminal neuralgia.Neurosurgery,2006,59(4 Suppl 2):ONS394-401.
[13] Ding W,Chen S,Wang R,et al.Percutaneous radiofrequencythermocoagulation for trigeminal neuralgia using neuronavigation-guided puncture from a mandibular angle.Medicine (Baltimore),2016,95(40):e4940.
[14] 乔梁,朱宏伟,陶蔚,等.神经导航引导下三叉神经半月节射频热凝术电生理及疗效研究.中国疼痛医学杂志,2015,21(11):862-864.
[15] 徐振宇,王佩珊,杨欣艳.国人颅骨卵圆孔的观测及其应用解剖的研究.黑龙江医药科学,2011,34(4):112.
[16] 张环,程敏,郭志刚,等.应用3D CT三维重建方法观察颅底翼突外侧板遮挡卵圆孔的情况.中国实验诊断学,2018,22(4):688-689.
[17] 程敏,王涵,李朝辉,等.颅底3D-CT重建测量卵圆孔在三叉神经射频热凝术中的作用.中国实验诊断学,2018,22(2):197-199.