背景:舌咽神经痛(GPN)是同时引起头痛和面部疼痛的病症。GPN的治疗与三叉神经痛的治疗相似。如果口服药物保守治疗失败,则需要开颅手术微血管减压(MVD)或射频(RF)治疗。因此,治疗GPN时,射频治疗靶点的选择至关重要.然而,简单地通过茎突定位找到舌咽神经是具有挑战性的。
方法:前瞻性,临床研究。
方法:麻醉科和疼痛医疗中心,嘉兴,中国。
目的:比较CT(CT)引导下射频治疗对GPN的临床效果,地图集的横向过程,茎突过程用于仅由茎突过程指导的治疗。
方法:2016年8月至2019年12月,19例GPN神经痛患者在单纯茎突CT引导下进行射频治疗。(这些患者包括茎突组的单定位(SL),其中射频治疗的目标是茎突一半的后内侧)。2020年1月至2022年12月,16例GPN患者在宫颈CTA(CT血管造影)的CT引导下进行RF治疗。地图集的横向过程,和茎突。(这些患者被置于TL组,其中RF治疗的目标是颈内动脉和颈内静脉之间的间隙,该间隙位于Atlas横突下边缘的水平茎突后面)。在针头插入部位皮下注射2%的利多卡因,和带有21号钝射频针的探针(型号:240100,制造商:EnglanderMedicalTechnologyCo.,Ltd.)慢慢向目标前进。之后,引入了射频探头,然后应用射频仪器(型号:PMG-230,加拿大Baylis公司)的低频(2Hz)和高频(50Hz)电流进行刺激。成功的测试被定义为0.5-1.0mA电流刺激,可以引起咽部的原始疼痛区域,内耳,或者两者兼而有之,对迷走神经或副神经没有任何异常刺激。如果第一次测试不成功,然后在SL组中,针尖的位置被调整到茎突的远端,在三重定位(TL)组中,针尖深度经过微调。测试成功后给予连续射频治疗。RF温度为95ºC,持续180秒。第一次穿刺到达目标的时间,穿刺路径,第一次测试的成功率,舌咽神经被发现的时间,调整射频针头位置的频率,术中和术后并发症的发生率,并记录治疗效果。
结果:人口统计学数据没有显着差异,例如年龄,病史,横向分类,两组之间的疼痛评分,但TL组女性比例高于SL组.术前根据设计的穿刺路径确定所有患者的穿刺目标。两组在第一次穿刺到目标的时间上没有差异(5.05±1.22vs.5.82±1.51,P=0.18),和设计穿刺深度(3.65±0.39vs.4.04±0.44)。穿刺角度的差异(13.48±3.56与17.84±3.98,P<0.01)有统计学意义,在SL组中有8例,经过60分钟的测试,舌咽神经无法找到,因此射频治疗终止.同时,此问题仅发生在TL组中的2例病例中。SL组有3例宫颈血肿,2例出现一过性声音嘶哑和咳嗽,而TL组,分别,0和这些问题的一个案例。两组都没有死亡。
结论:在未来的研究中应该收集更多的临床数据。
结论:当使用RF治疗GPN时,使用颈部CTA的三重定位更容易发现舌咽神经,以寰椎横突和茎突为目标,在寰椎横突下边缘水平确定茎突后颈内动脉的前内侧边缘。当仅针对茎突的后内侧边缘时,舌咽神经更难定位。90ºC下对GPN进行180秒射频消融的单次有效率可达到87.5%(14/16),这表明该治疗具有临床应用的潜力。
BACKGROUND: Glossopharyngeal neuralgia (GPN) is a condition that causes simultaneous headache and facial pain. The treatment for GPN is similar to the treatment for trigeminal neuralgia. Craniotomy microvascular decompression (MVD) or radiofrequency (RF) therapy is needed if conservative treatment with oral drugs fails. Therefore, the choice of radiofrequency therapy target is essential when treating GPN. However, finding the glossopharyngeal nerve simply by styloid process positioning is challenging.
METHODS: Prospective, clinical research study.
METHODS: Department of Anesthesiology and Pain Medical Center, Jiaxing, China.
OBJECTIVE: To compare the clinical effects of computed tomography (CT)-guided RF treatments on GPN when the triple localization of cervical CT, the transverse process of the atlas, and the styloid process is used to those achieved when the treatments are guided by the styloid process alone.
METHODS: From August 2016 to December 2019, 19 cases of GPN neuralgia were treated by radiofrequency under the guidance of CT guided by the styloid process only. (These patients comprised the single localization (SL) of styloid process group, in whom the target of the RF treatments was the posterior medial side of half of the styloid process). From January 2020 to December 2022, 16 cases of GPN were treated by RF under the guidance of CT with cervical CTA (CT angiography), the transverse process of the atlas, and the styloid process. (These patients were placed in the TL group, in whom the target of RF therapy was the gap between the internal carotid artery and the internal jugular vein behind the horizontal styloid process at the lower edge of the transverse process of the atlas). Two percent lidocaine was injected subcutaneously at the needle insertion site, and a stylet with a 21-gauge blunt RF needle (model: 240100, manufacturer: Englander Medical Technology Co., Ltd.) was slowly advanced toward the target. After that, an RF probe was introduced, then low (2 Hz)- and high (50 Hz)-frequency currents of the RF instrument (model: PMG-230, Canada Baylis company) were applied to stimulate. A successful test was defined as a 0.5-1.0 mA current stimulation that could induce the original pain area in the pharynx, the inner ear, or both, without any abnormal irritation of the vagus or accessory nerves. If the first test was unsuccessful, then in the SL group, the needle tip\'s position was adjusted to the distal end of the styloid process, and in the triple localization (TL) group, the needle tip depth\'s was fine-tuned. A continuous RF treatment was given after a successful test. The RF temperature was 95ºC for 180 seconds. The time that the first puncture reached the target, the puncture paths, the success rate of the first test, the time that the glossopharyngeal nerve was found, the frequency of adjustments to the position of the RF needle, the incidence of intraoperative and postoperative complications, and the therapeutic effects were recorded.
RESULTS: There were no significant differences in demographic data such as age, medical history, lateral classification, and pain score between the groups, but the TL group had a higher proportion of women than did the SL group. All patients\' puncture targets were identified according to the designed puncture path before the operation. There was no difference between the 2 groups in the time of the first puncture to the target (5.05 ± 1.22 vs. 5.82 ± 1.51, P = 0.18), and the designed puncture depth (3.65 ± 0.39 vs. 4.04 ± 0.44). The difference in puncture angles (13.48 ± 3.56 vs. 17.84 ± 3.98, P < 0.01) was statistically significant, and in 8 cases in the SL group, the glossopharyngeal nerve could not be found after 60 minutes of testing, so the RF treatment was terminated. Meanwhile, this problem occurred in only 2 cases in the TL group. There were 3 cervical hematoma cases and 2 cases of transient hoarseness and cough in the SL group, whereas the TL group had, respectively, 0 and one cases of those issues. There was no death in either group.
CONCLUSIONS: More clinical data should be collected in future studies.
CONCLUSIONS: When using RF as a treatment for GPN, the glossopharyngeal nerve is easier to find by using the triple positioning of the cervical CTA, the transverse process of the atlas and the styloid process as the target to determine the anterior medial edge of the internal carotid artery behind the styloid process at the level of the lower edge of the atlas transverse process. The glossopharyngeal nerve is more difficult to locate when only the posterior medial edge of the styloid process is targeted. The single-time effective rate of 180 seconds of RF ablation at 90ºC for GPN can reach 87.5% (14/16), suggesting the treatment\'s potential for clinical application.