Comparison The Effect And Security Of CT 3D Imaging-Guided With C-arm Guided In Radiofrequency Thermocoagulation Of Trigeminal

Objective:To explore the clinical efficacy,the numbers of puncture and complications of trigeminal nerve radiofrequency thermocoagulation guided by computed tomography(CT)three-dimensional imaging and C-arm.To compare the clinical efficacy and safety of the two methods in order to find a better treatment and obtain the data of the external orifice of the foramen ovale according to the Hartel puncture path.Methods:From March 2015 to March 2016,40 patients with primary trigeminal neuralgia treated in pain clinic of Xuanwu Hospital of Capital Medical University were selected in the research.Before the operate head magnetic resonance(MRI)examination was performed to exclude the occupying lesions.Informed the relevant risks,the patients voluntarily accepted interventional therapy and signed a consent form.According to single and double,40 patients were divided into observation group(A)and control group(B),with 20 cases in each group.Observation group(A)used CT 3D imaging to guide to puncture the foramen ovale,while the control group(B)used c-arm.After entering the operation room patients took supine position and were connected with monitor to record the heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP)and blood oxygen saturation(SPO2).The patients were established the venous access and given atropine 0.5mg.A group patients underwent CT cranial scanning and three-dimensional reconstruction,spun 3D imaging to display the maximum area of the external orifice of the foramen ovale by the Hartel puncture path,observed influencing factors of puncture and measured the external orifice of the foramen ovale.B group irradiated of oval foramen with C-arm.After observing the position of oval foramen and designing the puncture path,the operator disinfected local skin and shopped sterile single.Used 1% lidocaine to local anesthesia at mandibular angle 3cm,puncture RF needle(Type: 22G)from mandibular angle 3cm lateral to the foramen ovale.CT three dimensional reconstruction were used to determine the tip of RF needle located at the oval foramen in the A group while B group used the C-arm.After successful copied the pain in the sensory and motor test,operator did continuous radio frequency 70?,120 s,2 times.Radio frequency needle were removed and the puncture point were pasted with the sterile dressing.The patients were observed in 30 minutes and then backed to the ward.In order to compare the differences of preoperative VAS and the clinical effect after operation in two groups,the patients were measured with visual analogue scale(VAS)score at the time before the surgery(T0),discharge time(T1)and one year postoperatively(T2).The number of puncture and complications after operation were observed.Results:1?Preoperative(T0)pain VAS score resultsThe preoperative VAS score of A group is 8.85±1.04,the VAS score of B group is 8.65±1.04,and the preoperative VAS score of the two groups is not statistically significant(P>0.05).2?Discharge time(T1)pain VAS scores resultsVAS score of patients in the A group is 1.05±0.69,and the VAS score is 1.05±0.83 in the B group after the surgery.The two groups have no significant difference in VAS scores(P>0.05).3?One year postoperatively(T2)pain VAS scores resultsVAS score of patients in the A group is1.45±1.00,and the VAS score is1.65±1.60 in the B group after the surgery.The two groups have no significant difference in VAS scores(P>0.05).4?the number of puncture in two groupsIn the A group,the rate of the first needle insertion is 90%,while the rate of the first needle insertion in B group is 50%.The first needle access rate of A group is significantly increased than that of the patients in group B(P<0.05).5?the puncture time of two groupsThe puncture time of the A group is 25.8±17.27 seconds,and The puncture time of the B group is 42.3±25.71 seconds.The puncture time of A group is significantly decreased than that of the B group(P<0.05).6?the complications of two groupsA group appeared only 2 cases of postoperative headache.In group B,3 cases showed postoperative headache,3 cases showed facial swelling,2 cases showed chewing weakness,and 1 case were vertigo and tinnitus after operation.The incidence of complications in group B was significantly higher than that in group A(P<0.05).7?the data of the external orifice of the foramen ovale according to the Hartel puncture pathThe long diameter of the external orifice of the foramen ovale is 5.01±2.14 mm,and the short diameter is 3.10±2.10 mm.Conclusion:Both of trigeminal nerve(TN)radiofrequency thermocoagulation guided by CT three dimensional reconstruction and C-arm can significantly reduce the degree of pain in the treatment of primary trigeminal neuralgia.Radiofrequency thermocoagulation of trigeminal nerve guided by CT three-dimensional reconstruction in the process of puncture foramen is superior to the operation guided by C-arm.The operation guided by CT three-dimensional reconstruction can significantly reduce the incidence of complications and should be more security.