The Clinical Study Of Percutaneous Puncture Gasserian Ganglion By Radiofrequency Treating Targeted Of The Third Division Trigeminal Neuralgi

Object:the positioning of radiofrequency(RF) therapy of isolated third division (Ⅲ)idiopathic trigeminal neuralgia is determined by location of foramen ovale using C-arm X-ray machine, then observe the efficacy and Security, further explore the clinical treatment of trigeminal neuralgia radiofrequency law.Methods:45patients who have isolated third division(Ⅲ) idiopathic trigeminal neuralgia were involved in our study.After foramen ovale were substantially showed by C-arm X-ray machine,all patients were randomly divided into3groups of15individuals according to the equipartition of foramen ovale’s long axis to the outer region(A group), middle region(B group) and inner region(C group).By electrically evoked detection, evaluation the RF scope is to reach the third branch nerve fiber damage.Recorded the VAS score of the postoperative following-up immediate postoperative,48h,lweek,months3,6andl2months,postoperative efficacy,complications and recurrence rate.Results:All of45patients who have the third division(Ⅲ) idiopathic trigeminal neuralgia were involved in our study have completed the gasserian ganglion radiofrequency successfully. Patients generally:the three groups at baseline age, gender, disease duration, and there was no significant difference in ipsilateral, comparable (P>0.05).Foramen ovale showed the vertical axis direction angle:28.4±2.85°; Horizontal angle:left20.92±3.71°,right22.09±3.16.Paracentesis depth: group A6.35±0.60cm; group B:6.74±0.41cm; group C6.87±0.42cm.The the sensation evoked potential of group C is more than1.0mA and the motion evoked potential is more than2.0mA, neither of them evoking,the third branch of the pain and masticatory muscle movement. So we change of puncture to inner or outer region The patients divided into two groups:group A22cases; group B23cases; The evoked potential in two group:the sensation evoked potential:IA=0.37±0.16mA\IB=0.60±0.13mA; the motion evoked potential:IA=1.27±0.24mA、Ib=1.70±0.16mA.The score of visual analog scale(VAS) in postoperative follow-up:there was no statistical(P>0.05)difference between group A and group B; all of45patients pain score of visual analog scale(VAS) in post-operation follow up decreased significantly (*P<0.05), the radiofrequency therapy of idiopathic trigeminal neuralgia effect. There was no statistical(P>0.05)difference between group A and group B preoperative and follow-up groups postoperatively on48hours,1week, mouths3,6and12. The complications of operation:group A:10patients feel facial abnormal sensation only in the section Ⅲ dominated region,3patients feel masticatory muscle strength decline,5patients feel facial swelling; group B:13patients feel facial abnormal sensation in the section Ⅲ dominated region,6of them have the same feel in the section Ⅱ dominated region,1patients find transient eyebrow on the forehead area numbness,2patients feel masticatory muscle strength decline,8patients feel facial swelling; Maxillofacial paresthesia:analyzed statistically with the cases of Ⅰ、Ⅱ、 Ⅲ in group A and group B. there was no statistical(P>0.05)difference between I and Ⅲboth in group A and group B, There was statistical(P<0.05)difference between group A and group B in the section Ⅱ dominated region. Additional the cases of masticatory muscle strength decline, facial swelling also have no statistical in group A and group B.There was no recurrence in1year follow up.Conclusion:The outer area of the foramen oval was puncture the best position of the third division idiopathic trigeminal neuralgia, the inner area was not recommended; Targeting can be positioned middle area or outer area of the foramen oval for therapeutic purposes.However, the middle area easily lead to postoperative complications among the second facial control zone regional paresthesia.