| Objectives1To study the anatomical structure of foramen ovale and inside thecavernous sinus, the adjacent relationship between foramen ovale and the internal structureof the cavernous sinus in the path of puncture through foreman ovale to the trigeminalganglion. To maesure the relatively safe puncture angle and depth in the path of puncturethrough foreman ovale to the trigeminal ganglion in CT image, establish CT imagepuncture modle,and therefore provide anatomical bases for puncture the foramen ovale andprotect adjacent neurovascular under three-dimensional CT guided radiofrequencythermocoagulation therapy in primary trigeminal neuralgia.2To compare the efficacyand safety between three-dimensional CT guided radiofrequency thermocoagulationtherapy in primary trigeminal neuralgia and.unarmed puncture.Methods1In the study of anatomy, twenty cadaver heads for totle of40sides afterperfused with colored latex in their vascular system were examined. The skull was openedthe brain was carefully removed. Observation of the lateral wall of cavenous sinus and itsinternal structure under the microscope. Measure of the size of foramen ovale, theanatomical relation between the internal neurovascular of cavernous sinus and foramenovale. Then puncture trigeminal ganglion trough foramen ovale,observe the position ofneedle in the skull base, measure the distance and angle of needle in CT image. All datawere statistical processed and presented in mean (range and measured value) style.2Inthe clinical study,48patients with primary trigeminal neuralgia under three-dimensionalCT guided radiofrequency thermocoagulation therapy as treatment group. with21cases ofunarmed puncture trigeminal semilunar ganglion radiofrequency thermocoagulationtherapy were selected as control group. Changes in pain after operation were comparedbetween two groups, respectively after first,3,6, and12months follow-up treatment effect,complications and recurrence.Results1In the study of anatomy, Cavernous sinus is the irregular lacuna between thetwo layer of dura mater, located in the middle cranial fossa. The longest diameter ofcavernous sinus was (19.52±2.32) mm, the most width was (10.26±2.49) mm, the mostheight was (11.49±1.85) mm. There are5part in the internal carotid artery of cavernoussinus and there are3main branches. The distance between the upper edge of internalcarotid artery and the bottom of cavernous sinus was (10.30±3.13) mm. The shortestdistance between foramen ovale and internal carotid artery was (13.43±2.98) mm, theincluded angles between the shortest distance line which from foramen ovale to internalcarotid artery and sagittal plane was (41.73±8.49)°, the included angles between theshortest distance line which from foramen ovale to internal carotid artery and canthomeatalplane was (59.20±7.87)°. There were down from the oculomotor nerve, trochlear nerve,ophthalmic nerve, maxillary nerve by and abducent nerve was inside on the outer wall ofcavernous sinus. The distance between the upper edge of oculomotor nerve and the bottomof cavernous sinus was (10.39±2.39) mm. The shortest distance between foramen ovale and oculomotor nerve was (13.40±2.90) mm, the included angles between the shortestdistance line which from foramen ovale to oculomotor nerve and sagittal plane was (46.71±9.27)°, the included angles between the shortest distance line which from foramen ovaleto oculomotor nerve and canthomeatal plane was (51.76±7.58)°. The distance between theupper edge of trochlear nerve and the bottom of cavernous sinus was (10.36±2.43) mm.The shortest distance between foramen ovale and trochlear nerve was (12.71±3.40) mm,the included angles between the shortest distance line which from foramen ovale totrochlear nerve and sagittal plane was (42.19±10.25)°, the included angles between theshortest distance line which from foramen ovale to trochlear nerve and canthomeatal planewas (51.38±6.60)°. The distance between the upper edge of abducent nerve and thebottom of cavernous sinus was (9.82±2.05) mm. The shortest distance between foramenovale and abducent nerve was (12.69±2.92) mm, the included angles between the shortestdistance line which from foramen ovale to abducent nerve and sagittal plane was (46.23±7.85)°, the included angles between the shortest distance line which from foramen ovale toabducent nerve and canthomeatal plane was (52.13±5.79)°. Foramen ovale located in themiddle cranial fossa. Trigeminal nerve branch mandibular nerve went through foramenovale. The length of foramen ovale was (6.80±1.04) mm and the breadth was (3.77±0.98)mm. CT image puncture model data establishment is that the distance between foramenovale and the surface puncture point, trigeminal ganglion were (77.23±6.13) mm,(14.07±2.03) mm. The included angle between needle and coronal plane, sagittal plane, andcanthomeatal plane ware (37.10±8.91)°,(30.30±5.91)°,and（62.18±7.70）°.2In theclinincal study, treatment group operation success rate of first puncture and efficiency werehigher than the control group, with statistical difference, complications of neurovascularinjury in treatment group than in the control group, with statistical difference, the totaleffective rate of treatment group was higher than that of the control group, the treatmentgroup the recurrence rate was lower than the control group, no significant difference.Conclusions1CT image puncture model building has the vital significance to theprotection of cavernous sinus and its internal neurovascular in radiofrequencythermocoagulation therapy.2Three-dimensional CT guided puncture and CT imagemodel is capable improve the puncture success rate, reduce complications, thepercutaneous puncture semilunar ganglion radiofrequency thermocoagulation for treatmenttrigeminal neuralgia more safety, technology promotion. |
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