3D重建在三叉神经第二支射频治疗穿刺路径选择中的应用

摘要

Objective:To explore the application of 3D reconstruction in choosing the approach for radiofrequency treatment of V2 of trigeminal nerve.Methods: 34 patients with trigeminal neuralgia (V2/V2+V3) were included in the study. After taking a CT scan and 3D reconstruction of each patient's skull, puncture through three types of approach were simulated and evaluated in the computer, including puncture of foramen ovale through Hartel approach, foramen rotundum through pterygopalatine fossa (PPF) and inferior orbital fissure (IOF), respectively. According to whether simulation of puncture could be performed successfully, the evaluation results were divided into two groups: successful puncture and failed puncture. Results:Puncture simulation and evaluation of all 34 cases were conducted, of which 2 cases (5.8%) of puncture through Hartel approach, 1 case (2.9%) of puncture through pterygopalatine fossa and 8 cases (23.5%) of puncture through inferior orbital fissure were failed. Puncture of foramen ovale through Hartel approach and foramen rotundum through pterygopalatine fossa are easier than puncture of foramen rotundum through inferior orbital fissure (P< 0.05).Conclusion: 3D reconstruction technigue provides important guidance for the preoperative planning of radiofrequency treatmentof V2 of trigeminal nerve. Considering the precision of the treatment, puncture of foramen rotundum through pterygopalatine fossa is the preferred choice for treatment of trigeminal neuralgia (V2/ V2+V3).%目的：探索3D重建技术在三叉神经第二支射频治疗穿刺路径选择中的作用。方法：34例三叉神经第二支或者第二支合并第三支疼痛患者，采用3D重建技术对卵圆孔Hartel入路、圆孔外口颧弓下入路、圆孔外口经眶入路三种穿刺路径进行模拟穿刺并评估，根据模拟穿刺成功与否将穿刺入路分为：“可穿刺”入路与“不可穿刺”入路。结果：34例患者中“不可穿刺”比例：Hartel入路为5.8%（2例），颧弓下入路为2.9%（1例），经眶入路为23.5%（8例），圆孔外口颧弓下入路和卵圆孔Hartel入路较圆孔外口经眶入路更易穿刺成功(P <0.05)。结论：3D重建技术对三叉神经第二支射频治疗穿刺路径选择有重要指导作用，考虑到治疗精准性，圆孔外口颧弓下入路可作为穿刺优选路径。