目的:当用于治疗颅面疼痛时,CT引导下的三叉神经束核切开术(TR-NC)通常在局部麻醉下进行。不幸的是,对于严重疼痛的患者,局部麻醉不足,以至于他们无法在清醒时耐受所需的头部定位。这项研究旨在将与全身麻醉下进行的TR-NC相关的先前发现背景化。作者研究了可能影响术后疼痛结果的临床和手术因素。
方法:这是一项回顾性的单机构队列研究,对象是2012年至2019年在单一机构进行全身麻醉下经皮CT引导TR-NC的患者。分析结果数据。
结果:25例患者在全身麻醉下接受了CT引导的TR-NC手术;23例符合纳入标准,总共接受了31例手术。手术成功率为74%(23/31)。大约50%和40%的手术可以缓解疼痛至少6个月和12个月。分别。疼痛缓解的中位持续时间为153天。不良事件,所有轻微和短暂的,发生在6/31(19%)的手术后。体重指数>25的患者不太可能经历成功的TR-NC(p=0.045)。较高的电极消融温度(p=0.033)和相对于正中矢状面更多的内侧进入轨迹(p=0.029)表明手术成功。
结论:这些结果表明,在全身麻醉下进行CT引导的TR-NC是安全有效的。发现术后结果与许多临床和手术因素有关。应在未来的背景下进一步探索和评估这种协会,更强大的分析。
When used to treat craniofacial pain, CT-guided trigeminal
tractotomy-nucleotomy (TR-NC) is usually performed with local anesthesia. Unfortunately, local anesthesia is insufficient for patients with such severe pain that they cannot tolerate the required head positioning while awake. This study aimed to contextualize previous findings associated with TR-NC performed under general anesthesia. The authors examined clinical and operative factors that could impact postoperative pain outcomes.
This is a retrospective single-institution cohort study of patients who underwent a percutaneous CT-guided TR-NC under general anesthesia at a single institution between 2012 and 2019. Outcome data were analyzed.
Twenty-five patients underwent CT-guided TR-NC procedures under general anesthesia; 23 met the inclusion criteria and underwent a total of 31 procedures. The procedure success rate was 74% (23/31). Approximately 50% and 40% of procedures provided pain relief for at least 6 and 12 months, respectively. The median duration of pain relief was 153 days. Adverse events, all minor and transient, occurred following 6/31 (19%) of procedures. Patients with a body mass index > 25 were less likely to experience a successful TR-NC (p = 0.045). Higher electrode ablation temperatures (p = 0.033) and more medial entry trajectories relative to the midsagittal plane (p = 0.029) characterized successful procedures.
These results suggest that CT-guided TR-NC performed under general anesthesia is safe and effective. Postoperative outcomes were found to be associated with a number of clinical and operative factors. Such associations should be further explored and evaluated in the context of future, better-powered analyses.