Study Of Radiofrequency Thermocoa Gulation For Treatment Of Primary Trigeminal Neuralgia

PART ONE:CLINICAL STUDY OF RADIOFREQUENCY THERMOCOAGULATUON GUIDED WITH DSA POSITIONING FOR TREATMENT OF PRIMARY TRIGEMINAL NEURALGIAObjective:To observe the clinical efficacy and safety of radiofrequency thermocoagulation on the treatment of primary trigeminal neuralgia (PTN) guided with digital substraction angiography (DSA) in short-term, mid-term prospect.Methods: Twenty-seven patients of PTN were positioned by DSA, and then treated with radiofrequency thermocoagulation. The visual analogue scale (VAS) scores, clinical efficacy and complication were observed nearly post-treatment. The effect in mid-term was assessed in secondary follow-up.Results: All patients were punctured successfully. After treatment, all patients have pain relief. VAS scores on day 1,day 3, week 1 after radiofrequency thermocoagulation were 2.12±0.64,1.04±1.02,0.46±0.31 respectively , decreased compared with that before treatment (P<0.01), and the satisfactory rate were 55.6%,74.1%,92.6% respectively. No serious complication occurred in all of the patients.22 patients were involved in the follow-up survey 1 year after radiofrequency thermocoagulation, and the satisfactory rate was 86.4%, 1 patient recurred, the recurrence rate was 4.5%.Conclusion: Radiofrequency thermocoagulation guided with DSA for the treatment of primary trigeminal neuralgia is effective and safe. PART TWO:THE EXPERIMENTAL STUDY OF RADIOFREQUENCY THERMOCOAGULATIONON SEMILUNAR GANGLION OF TRIGEMINAL NEURALGIA RATS FOLLOWING CHRONIC CONSTRICTION INJURYObjective: To observe the gross appearance and histological changes of radiofrequency thermocoagulation (RA) on semilunar ganglions of trigeminal neuralgia rats following chronic constriction injury, further discuss the relationship of damage and temperature, time.Methods: Thirty-six male Sparague-Dawley(SD) rats,thirty-three of them had chronic constricting injury (CCI). Week 2 after CCI, the thirty-three rats were divided into three groups randomly: RA group (group R, n=24), shamed operation group (group S, n=6), operation control group (group C, n=3). All the ganglions of the rats were exposed by middle fossa craniotomy. The group R was divided into eight groups randomly and has RA among the deferent parameter of temperature and time. Group S only had puncturation, group C didn't have puncturation and RA. Normal control group (group N, n=3) did not have CCI, puncturation and RA. After puncturation or RA cut off the ganglions of group R and S. Group C and N were cut off the ganglions directly. Measured the diameter of damage and observed the gross appearance and histological changes in the light microscope. Results: Compared with group N, group S and group C had no differences both on gross and light microscopic observation. Under 65。C, there were no differences in group R either on gross or light microscopic observation; there were slight lesions under 70。C; while under 75。C and 80。C,group R had significant solidification and the diameter of damage was larger than group 70。C(P<0.01). In the light microscope, the neurons have different degrees of damage, much higher the temperature and much longer the time, much serious of the neuron.Conclusion: RA under 75。C and 80。C can produce semilunar ganglion cell degeneration, and the degree depends on the temperature and time of RA.