CAJ | 학술논문

目的总结Dyna-CT在穿刺卵圆孔,确定球囊位置及形态,进而辅助经皮微球囊压迫治疗三叉神经痛的经验.方法回顾分析经皮微球囊压迫术中使用Dyna-CT进行三维重建治疗20例三叉神经痛的病例资料,在穿刺时确定穿刺针与卵圆孔的关系及角度,在压迫时确定球囊的位置、形态,测定体积,并进行随访.结果穿刺针在正位与中线成角15.17°～35.48°,平均25.28°,侧位与Reid基线成角37.46°～ 53.18°,平均46.09°.球囊的体积为568.2 ～891.4 mm3,平均766.1 mm3.20例术后症状均完全缓解,4例出现咬肌无力合并面部轻度痛觉减退.随访时间6～22个月,平均13.3个月,所有病例无复发,术后并发症消失.结论 Dyna-CT辅助经皮微球囊压迫术能够不依赖患者体位,方便地观察卵圆孔,确定穿刺方向,准确地对穿刺针方向及深度进行调整,立体全面地观察及测定穿刺针的角度、球囊的位置、形态和容量,从而降低手术并发症,改善患者预后.
목적 총결Dyna-CT재천자란원공,학정구낭위치급형태,진이보조경피미구낭압박치료삼차신경통적경험.방법 회고분석경피미구낭압박술중사용Dyna-CT진행삼유중건치료20례삼차신경통적병례자료,재천자시학정천자침여란원공적관계급각도,재압박시학정구낭적위치、형태,측정체적,병진행수방.결과 천자침재정위여중선성각15.17°～35.48°,평균25.28°,측위여Reid기선성각37.46°～ 53.18°,평균46.09°.구낭적체적위568.2 ～891.4 mm3,평균766.1 mm3.20례술후증상균완전완해,4례출현교기무력합병면부경도통각감퇴.수방시간6～22개월,평균13.3개월,소유병례무복발,술후병발증소실.결론 Dyna-CT보조경피미구낭압박술능구불의뢰환자체위,방편지관찰란원공,학정천자방향,준학지대천자침방향급심도진행조정,입체전면지관찰급측정천자침적각도、구낭적위치、형태화용량,종이강저수술병발증,개선환자예후.
Objective Percutaneous microballoon compression (PMC)is a well-established technique for treatment of trigeminal neuralgia (TN).However,direct puncture of the foramen ovale (FO) is sometimes difficult and there have been well-reported complications from cannulating the FO.We present the use of Dyna-CT for cannulating the FO and determining the balloon' s position and volume.Methods Dyna-CT was used to perform image reconstruction in 20 patients.The optimal working projection was generated and further fluoroscopic data was used to determine the needle's relationship to the foramen during puncture.Furthermore,the balloon position and 3-dimensional shape were verified with Dyna-CT during balloon compression.The needle position and the balloon volume were further calculated.Results Dyna-CT allows quick,safe,and easy cannulation of the FO.It provided 3-dimensional imaging which were more elaborate than the classic pear shape's imaging for determining correct positioning.The angle of introducing cannula ranged from 15.17°-35.48°rotation to the midline with an average of 25.28°and 37.46°-53.18°angulations to the Reid line with an average of 46.09°.The volume of the inflated balloon ranged from 568.2 mm3to 891.4 mm3 with an average of 766.1 mm3.All the patients were pain free after PMC.2 patients had resolvable masseter weakness and fine touch loss.No recurrent of TN when followed up.Conclusions Dyna-CT demonstrated three distinct advantages over the standard technique:Firstly,the FO can be better visualized independent of the patient's position.Secondly,needle correction or insertion can be performed much easier because of the direct fluoroscopic control.Thirdly,the needle position,balloon position,balloon configuration,and the volume of the inflated balloon is more reliably determined than with the submental projection.The use of dyna-CT could decrease the incidence of complications reported with the standard fluoroscopic technique.