Aimee Goel, Girish Kulkarni, Alexandru Cotici, Alessandro Paluzzi, Tom Hayton, Ramesh Chelvarajah
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引用次数: 0
Abstract
Objectives: Glycerol rhizotomy is an established treatment for medically refractory trigeminal neuralgia in select cases where microvascular decompression is contraindicated or not preferred. The standard approach is to inject a fixed volume of glycerol using Hartel's technique into Meckel's cave. We discuss a 'volume-maximised' technique of measuring the volume of Meckel's cave using intra-operative fluoroscopy and injecting an equivalent volume of glycerol such that every patient receives a tailored quantity of glycerol dependent on the volume of Meckel's cave. The safety and efficacy of this approach is analysed.
Methods: A retrospective analysis of 53 procedures where volume-maximised glycerol rhizolysis was utilised over a 7-year period (2012 -2018) at a single centre by the senior author was carried out. The incidence and duration of pain freedom and complications incurred over a median follow-up period of 8 years were analysed.
Results: 37 procedures were carried out for typical trigeminal neuralgia, 13 for secondary trigeminal neuralgia, and 3 for atypical trigeminal neuralgia. Overall, pain freedom was achieved in 85% cases, and 92% in patients with typical trigeminal neuralgia. Median duration of pain freedom in patients with typical trigeminal neuralgia was 63 months, versus 6 months in those with secondary trigeminal neuralgia (p < 0.00001). 14 procedures (26.4%) resulted in mild and temporary complications. 54.7% of cases experienced hypoaesthesia in a distribution similar to or less extensive than the distribution of trigeminal neuralgia. The presence of hypoaesthesia post-procedure was highly predictive of longer pain freedom (95 months versus 8 months median pain freedom (p = 0.00003)).
Conclusions: Volume-maximised glycerol injection is safe and effective when compared to literature-reported outcomes post-standard volume glycerol injections. The duration of pain freedom achieved exceeds most literature-reported studies, with hypoaesthesia outcomes being comparable with previous studies. Pain freedom outcomes are more favourable in those with post-procedure hypoaesthesia.
目的:甘油根切断术是一种确定的治疗难治性三叉神经痛的方法，在某些情况下，微血管减压是禁忌或不首选。标准的方法是使用哈特尔的技术将固定体积的甘油注入梅克尔的洞穴。我们讨论了一种“体积最大化”技术，使用术中透视法测量梅克尔氏洞的体积，并注射等量的甘油，这样每个病人都能根据梅克尔氏洞的体积接受量身定制的甘油量。分析了该方法的安全性和有效性。方法:对资深作者在7年期间(2012 -2018年)在单个中心使用的53种方法进行回顾性分析，其中使用了最大体积甘油根解。分析了中位随访8年期间疼痛缓解的发生率和持续时间以及并发症的发生情况。结果:典型三叉神经痛37例，继发性三叉神经痛13例，非典型三叉神经痛3例。总体而言，85%的患者实现了疼痛缓解，92%的患者实现了典型的三叉神经痛。典型三叉神经痛患者疼痛缓解的中位持续时间为63个月，而继发性三叉神经痛患者为6个月(p p = 0.00003)。结论:与文献报道的标准体积甘油注射结果相比，最大体积甘油注射是安全有效的。疼痛缓解的持续时间超过了大多数文献报道的研究，与以前的研究相比，感觉减退的结果是相当的。术后感觉减退的患者疼痛缓解效果更好。
期刊介绍：
The British Journal of Neurosurgery is a leading international forum for debate in the field of neurosurgery, publishing original peer-reviewed articles of the highest quality, along with comment and correspondence on all topics of current interest to neurosurgeons worldwide.
Coverage includes all aspects of case assessment and surgical practice, as well as wide-ranging research, with an emphasis on clinical rather than experimental material. Special emphasis is placed on postgraduate education with review articles on basic neurosciences and on the theory behind advances in techniques, investigation and clinical management. All papers are submitted to rigorous and independent peer-review, ensuring the journal’s wide citation and its appearance in the major abstracting and indexing services.
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