ABSTRACT
Objective To observe the clinical effect of extracranial radiofrequency thermocoagulation in foramen ovale on trigeminal neuralgia of mandibular branch.Methods The clinical data of 107 patients with primary trigeminal neuralgia of mandibular branch,admitted to our hospital from January 2016 to December 2017,were collected.With oxygen inhalation and vital signs monitoring,percutaneous radiofrequency thermocoagulation of foramen ovale was performed under CT guidance.The inclination angle,puncture angle and depth,puncture operation time,intra-operative complications,and short-term and long-term results after operation were observed.Results All patients were punctured to the inside and the outside foramen of foramen ovale precisely under the guidance of CT location,and the inclination angle (angle between the puncture needle and the coronal plane),puncture angle (angle between the puncture needle and the sagittal plane),average puncture depth and average puncture operation time were (18.2±7.6)°,(15.9±4.6)°,(63.48±11.7) mm and (13.6±5.7) min,respectively.The pain in mandibular branch dominant area disappeared completely in 104 patients after radiofrequency thermocoagulation at 90 ℃ 120 seconds,and the sensation of needling in this area decreased;two patients had residual pain in anterior ear and temporal area,and one patient had residual pain in lingual tip side,which was cured after radiofrequency treatment again.No intracranial hemorrhage and infection complications occurred except for 21 with facial hematoma during operation.Follow up for 12-24 months showed 9 were recurrence.Conclusion For patients with primary trigeminal neuralgia of mandibular branch,the target of radioffequency therapy should be transferred from intracranial ganglion to extracranial trigeminal foramen (foramen ovale) for extracranial non-semilunar radiofrequency thermocoagulation therapy,which can obtain satisfactory results and improve the safety of radiofrequency therapy for trigeminal neuralgia.
ABSTRACT
Objective To observe the clinical effect of CT-guided percutaneous puncture of stylomastoid foramen and radiofrequency ablation on primary hemifacial spasm. Methods Twenty-seven patients with primary hemifacial spasm, admitted to and accepted CT-guided percutaneous puncture of stylomastoid foramen and radiofrequency ablation in our hospital from August 2018 to May 2019, were chosen in our study. Clinical data and efficacy of the patients were retrospectively analyzed. Results All patients were punctured to the stylomastoid foramen precisely under the guidance of CT localization; 21 could detect facial muscle twitch with 0.1-0.5 mA current, and positive results were also found in 6 patients with 0.5 mA current after adjusting the position of the needle tip. After standard radio frequency ablation (mean 83.3 ℃ for 23.7 seconds), 26 patients had complete disappearance of facial spasm, but left grade II (n=18) or grade III (n=8) facial paralysis; one patient with disappearance of abnormal electromyographic response waveform as the end criterion only partially relieved, but no facial paralysis. No facial hematoma, intracranial hemorrhage, infection, or death occurred. Follow-up for 2-12 months showed no recurrence or aggravation of facial paralysis. Conclusion CT-guided percutaneous puncture of stylomastoid foramen by radio frequency ablation can effectively treat primary hemifacial spasm, but there will be mild facial paralysis.