Objective: To investigate safety and efficacy of CT guided radiofrequency thermocoagulation in treatment of V2 trigeminal neuralgia through inferior orbital fissure and foramen rotundum apporach. Methods: 64 patients with V2 trigeminal neuralgia were involved. CT scanning was given firstly to evaluate the difficulty to puncture and determine the puncture path. The puncture point was in the inside of the junction of the lower orbital edge and the outer orbital edge. These patients passing through the evaluation were punctured under the CT guidance into foramen rotundum through inferior orbital fissure and then punctured to Gasserian ganglion as far as possible. Temperature-controlled radiofrequency therapy was conducted after puncture completed. Results: After the first evaluation with CT scan, 1 patient was excluded because puncture into foramen rotundum was considered too difficult and was punctured through Hartel approach. In the remaining 63 patients, 60 were punctured smoothly into foramen rotundum and then to Gasserian ganglion, while the tip of needle only reach the outside end of the foramen rotundum in other 3 patients. After treatment with temperature-controlled radiofrequency therapy, those 63 patients had a successful pain relief with obvious facial numbness but no any other serious complications. Conclusion: Guided by CT scanning, puncture to Gasserian ganglion or maxillary nerve through inferior orbital fissure and foramen rotundum approach is a safe, accurate and effective way in radiofrequency therapy of the V2 trigeminal neuralgia.%目的:探讨CT引导下经眶-圆孔穿刺入路在第2支三叉神经痛射频热凝治疗中的安全性和疗效.方法:对64例第2支三叉神经痛患者,先行CT扫描评估和确定穿刺径路.取眶外下缘交界处偏内侧为穿刺点,在CT引导下调整穿刺针的方向和深度,穿刺圆孔并成功定位后,行温控射频热凝治疗.结果:1例因CT扫描评估穿刺困难而改经Hartel前入路穿刺.余63例行经眶-圆孔穿刺,其中60例顺利穿刺达圆孔内和半月神经节,3例仅到达圆孔外口.治疗后疼痛均缓解,除面部麻木外,无严重并发症.结论:CT引导下眶-圆孔入路射频热凝治疗第2支三叉神经痛,定位准确,无严重并发症,安全性和治疗效果良好.
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