[Neuronavigation-assisted percutaneous radiofrequency thermocoagulation of trigeminal gasserian ganglion for refractory craniofacial pain].

Objective: Percutaneous radiofrequency thermocoagulation (RFT) of the Gasserian ganglion is an effective treatment for refractory trigeminal craniofacial pain.In the present study, we assessed the feasibility of accessing the Gasserian ganglion through the foramen ovale with neuronavigation guidance in the patients of trigeminal craniofacial pain. Method: We retrospectively analyzed forty-four patients with type Ⅰ trigeminal neuralgia who had undergone percutaneous RFT treatment in our hospital from June 2014 to December 2016.The patients were divided into fluoroscopy group and navigation group according to the intraoperative guiding manners for foramen ovale cannulation.We compared groups in terms of the duration of the whole RFT procedure and times of intraoperative fluoroscopy.We also analyzed the immediate and late outcome accessing by Barrow Neurological Institute (BNI) pain scale, as well as the complication rates in groups. Result: There were 32 patients in the fluoroscopy group and 12 in the navigation group.The duration of the surgical procedure in navigation group was less than that in fluoroscopy group (46±12 min versus 67±16 min, P=0.00), and times of intraoperative fluoroscopy was reduced (6.3±2.2 versus 1.3±1.6, P=0.00). The learning curve of navigation-aid RFT was not steep in the present study overall.There was no significant difference between groups regarding pain reduction at the immediate (P=0.07) or late follow-up (P=0.400) time points.However, the rate of pain reduction to BNI-Ⅰ grade was greater in navigation group (P=0.026). No significant difference in the complication rate between both groups, and no serious complications were observed in the both groups. Conclusion: Neuronavigation may be encouraged in trigeminal Gasserian ganglion RFT with better operating efficiency and less radiation exposure.The immediate and late therapeutic effects for craniofacial pain control were positive, whereas further studies are necessary.目的： 探讨神经导航辅助经卵圆孔三叉神经半月节射频热凝术(RFT)治疗三叉神经源性头面痛的临床应用价值。 方法： 回顾性分析2014年6月至2016年12月期间，于福建医科大学附属第一医院接受三叉神经半月节RFT治疗的44例Ⅰ型三叉神经痛患者。根据术中辅助定位方式，将该44例病例分为透视组(32例)与导航组(12例)，两组病例的一般情况差异无统计学意义。比较两组病例操作时长、术中透视次数、穿刺成功率、术后BNI疼痛评分等指标的差异性。 结果： 导航组术中操作时间较透视组显著缩短(46 min±12 min比67 min±16 min，P＝0.00)，并且导航组术中透视次数也显著减少(6.3次±2.2次比1.3次±1.6次，P＝0.00)。总体上，导航辅助RFT操作的学习曲线并不陡峭。两组间术后即刻疼痛缓解率差异无统计学意义，但BNI Ⅰ级缓解率存在显著性差异(导航组75%比透视组65.63%，P＝0.026)。两组病例均未出现严重并发症。 结论： 神经导航技术可能有利于提高三叉神经半月节RFT的操作效率，减少术中透视暴露。该技术治疗顽固性头面痛的近、远期疗效是肯定的，但仍需要进一步的研究论证。.