The Treatment Of Primary Trigeminal Neuralgia With Combination Of Radiofrequency And Chemical Destruction Under CT Imaging Guidance

Objective:Primary trigeminal neuralgia(PTN)is a chronic pathologic disease related to cranial nerve.Its etiology and mechanism have not been clear,clinical treatment methods are numerous,but there is no way to completely cure it.Currently in the pain department,radiofrequency and epirubicin injection interventional therapy under imaging guidance are widely used.However,the long-term efficacy cannot be guaranteed after radiofrequency treatment,and the recurrence rate is high.It takes 1 to 2 weeks for the effect of epirubicin injection treatment,and the early efficacy is not good.So in our study,we will discuss the curative effects of CT image-guided radiofrequency combined with chemical destruction of epirubicin for primary trigeminal neuralgia.Methods:72 patients with primary trigeminal neuralgia(? + ?)were selected and divided into three groups(n = 24)according to random number table method.The group A was selected to be treated with Pulse radiofrequency(PRF)of mandibular nerve through the foramen ovale under CT guided and Radiofrequency thermocoagulation(RFT)of maxillary nerve through the foramen infraorbitale;The group B was selected to be treated with PRF of mandibular nerve through the foramen ovale under CT guided and RFT of maxillary nerve through the foramen rotundum;The group C was selected to be treated with PRF of mandibular nerve through the foramen ovale under CT guided and RFT of maxillary nerve through the foramen rotundum,and Epirubicin was injected at the same time respectively.Numeric rating scales(NRS)and sleep time of all the patientswere recorded before and 1 day,2 weeks and 6 months after surgery.The clinical effective rate and recurrence of the patients were assessed by classification of Barrrow Neurollogical Institute(BNI),and the postoperative complications including facial hypoesthesia,decreased chewing power,keratitis,dizziness and facial swelling were recorded.Results:1.Changes in postoperative NRS scores at each time point in the three groups of patientsThe postoperative NRS of the three groups at each time point significantly decreased than which we obseved before surgery,and there were statistically significant difference in this parameter(P<0.05).One day after the operation,the NRS score of group B and group C was lower than that of group A(P<0.05),and no significant difference could be found in terms of this parameter between groups B and C(P>0.05).Two weeks and six months after the operation,there were statistically significant differences in NRS scores among groups A,B and C(P<0.05).Group A had the highest score,followed by group B,and group C had the lowest score.Group C had the best therapeutic effect.2.Changes in sleep time at each time point in the three groups of patientsThe sleep time of the three groups at each time point significantly increased than which we obseved before surgery,and there were statistically significant difference in this parameter(P<0.05).The variation trend of sleep time was consistent among the three groups,the sleep time of group C was higher than that of group A and group B(P<0.05),while no significant difference could be found in terms of this parameter between groups A and B(P>0.05).3.Comparison of clinical efficacy and recurrence in three groupsThe effective rates of group A at 1 day,7 days and 6 months after surgery were62.5%,58.3% and 41.7% respectively.The effective rates of group B were 79.2%,70.8% and 66.7% respectively.The effective rates of group C were 83.3%,95.8% and95.8% respectively.One day after surgery,there was no significant difference could be found in terms of this parameter among the three groups(P>0.05).Two weeks and six months after the operation,the effective rate of group C was higher than that of group A and group B,and there were statistically significant difference in this parameter(P<0.05).There was no significant difference could be found in terms of this parameter between the group A and group B(P>0.05).A total of 6(25%)patients in group A experienced recurrence,3(12.5%)patients in group B experienced recurrence,and none of the patients in group C experienced recurrence.4.The incidence of postoperative complications in three groups of patientsNo serious complications occurred in the three groups.One day after the operation,13 patients in group A had numbness in the cheek beside the alar,15 patients in group B and 14 patients in group C had facial numbness in the area of maxillary nerve innervation.After the operation,3 patients in group C presented mild headache symptoms,which disappeared after the treatment with oral analgesics.No decreased mastication and keratitis were found in the three groups.After surgery,10,9 and 11 patients in group A,group B and group C showed facial swelling,local ice cubes were given ice compress,and the swelling disappeared within 1 to 2 days.There was no significant difference in complications between the three groups(P>0.05).Conclusion:CT-guided radiofrequency through foramen rotundum and foramen ovale combined with adriamycin is the treatment for primary trigeminal neuralgia(? + ?).This method effectively combined the characteristics of trigeminal nerve's anatomical structure and physiological characteristics as well as the characteristics of radio frequency technology and chemical destruction with epirubicin.Its curative effect is quick,medium and long term curative effect is good,postoperative complication degree is slight,which is suitable for patients of all ages and worthy of further promotion and application in future clinical practice.