經皮低溫高頻熱凝療法使用在三叉神經痛病人之回溯性分析──二年經驗分享

A Retrospective Analysis of Patients with Trigeminal Neuralgia Who Underwent Percutaneous Controlled Lower Temperature Radiofrequency Thermocoagulation of the Gasserian Ganglion: 2-year-Experience

摘要（correct according to the English abstract）：三又神經痛是最常見的顱顏疼痛，常見的表現是三叉神經分布區，單側、尖銳、電擊般的反覆性疼痛。三又神經痛最常見的原因是周邊血管造成的壓迫。治療的方式包括藥物、手術及侵入性較小的經皮治療。在考慮所有經皮治療的效果，經皮熱凝療法在止痛效果及選擇性上具有最佳的證據支持。方法：在異丙酚的鎮靜下，在2年之間，16個三叉神經痛的患者總共接受了21次的經皮高頻凝療法， 我們用X-ray來定位Gasserian ganglion並給予電刺激0.2-1.0V （50Hz，0.2ms） 。高頻熱凝療法設定溫度在60-65度90秒，每個部位施行兩次。其中有4位（25%） 因為疼痛復發，接受大於一次之治療。結果：平均追蹤時間20.3±4.3月（9-24月） 。在一次或多次的治療後，有90.5%病人獲得急性疼痛控制。在首次治療後，有三個病人（14.3%） 早期復發（六個月內），5個病人（23.8%）晚期復發（六個月之後）。經兩年的追蹤，有7個病人（43.8%）只接受單次治療後仍獲得疼痛緩解。暫時的併發症包括輕度感覺異常（1位，4.7%），耳朵痛及耳鳴（1位，4.7%），臉部血腫（2位，9.5%）。沒有病人發生長期性的併發症及死亡。結論：經皮高頻熱凝療法是個有效、安全的治療方法。而相較於傳統60-80° C，相對低溫可以減少併發症的產生。若疼痛復發，可以再次以經皮低溫高頻熱凝療法反覆治療。

Introduction: Triginenal neuralgia (TN) is the most common form of cranial neuralgia. It was characterized by unilateral, sharp, electric-shock-type and recurrent pain confined to the somatosensory territory of the trigeminal nerve. The most common cause of TN is compression of the adjacent vessels. The treatment option includes pharmacology, surgery and percutaneous procedures. Considering to the effectiveness of all percutaneous interventions, radiofrequency thermocoagulation has the best evidence-supportive pain relief and selectivity. Methods: Under intravenous propofol light sedation, a total of 16 patients with trigeminal neuralgia underwent 21 percutaneous controlled radiofrequency trigeminal rhizotomy (RF-TR) procedures in 2 years. We confirmed the localization of RF needle within the Gasserian ganglion by the fluoroscopic guidance and electrical stimulation at 0.2 to 1 V (50 Hz, 0.2 ms). Thermocoagulation lesions were made at a temperature of 60 to 65∘C for 90 seconds twice at each target. There were 4 patients (25%) treated with multiple procedures due to the recurrence of pain. Results: The average follow-up time was 20.3±4.3 months (range, 9–24 months). Acute pain relief was reported in 90.5% of patients with a single procedure or multiple procedures. After the first procedure was performed, early pain recurrence (<6 months) was observed in 3 patients (14.3%) and late pain recurrent (>6 months) was observed in 5 patients (23.8%). At 2-year follow-up, 7 (43.8%) patients who underwent a single procedure had still experienced pain relief. Transient complications included minor dysesthesia in one patient (4.7%), ear pain and tinnitus in one patient (4.7%), facial hematoma in two patients (9.5%). There were no permanent severe mobility or mortality noted. Conclusion: Percutaneous RF-TR is an effective, safe treatment for trigeminal neuralgia. The relative lower temperature compare to the conventional (60-80∘C) thermocoagulation lesions could reduce the complications. The procedure may be repeated if pain recurs.