- 期刊
Percutaneous Trigeminal Ganglion Compression for Trigeminal Neuralgia
以經皮膚三叉神經節汽球壓迫阻斷手術來治療三叉神經痛
摘要
經皮膚三叉神經節汽球壓迫阻斷手術於1983年首先山Mullan和Lichtor所提出。其主要適應對象爲需接受外科手術治療三叉神經痛病患，包括接受其他手術後症狀復發的病患。而本科於1999年成功引進經皮膚三叉神經節汽球壓迫阻斷手術。由2000年6月至2001年6月，我們已順利地施行此一手術於100位三叉神經痛病患，其中男性46位；女性54位，年齡最大87歲；最小26歲，其中51位病患年齡在65歲或以上，其中有61位病患有眼支或多支的疼痛產生，1位病患爲雙側三叉神經痛，且只接受一側手術。麻醉時間約爲一小時，神經節壓迫時間爲0到90秒。94位病患於第一次手術後疼痛立即解除，術後疼痛立即緩解率可高達94%。全部病患沒有因爲麻醉而產生併發症，手術成功後，病患疼痛立即解除，取而代之的是持續性輕度到中度半側顏面麻木感和咀嚼肌力減弱情況，此情形絕大部分病患都能忍受，此種感覺麻木感和咀嚼肌力減弱情況大部分患者三個月後皆能獲得改善。無嚴重手術或麻醉併發症產生。除二位病患以門診手術方式治療外，其餘都住院手術治療。手術成功病患，在經過五年以上長期追蹤，結果發現術後二年內疼痛緩解率爲86.2%，術後三年內疼痛緩解率爲84%，整體而言，術後五年內疼痛緩解率爲71.3%。 所以此一經皮膚三叉神經節氣球壓迫阻斷手術爲治療三叉神經痛病患另一種手術選擇，雖然在手術技術上和麻醉技術上仍有需要特別注意之處。此一手術仍爲一最安全且有效的手術，尤其是高危險群病患，和年長病患。且我們五年追蹤報告發現，此一手術有很高的手術成功率，其五年內疼痛緩解率與開顱手術相當，此一結果與國外其它中心報告相近似。
並列摘要
Objective: The aim of this study was to evaluate outcomes and complication rates associated with percutaneous trigeminal ganglion compression (PTGC), followed up for at least 5 years. Methods: The authors report on 100 cases of trigeminal neuralgia treated by percutaneous trigeminal ganglion compression from June 2000 to June 2001. The operation was performed under general anesthesia with endotracheal intubation. Meckel's cave was cannulated with No.4 Fogarty catheter and the balloon was inflated for 70 to 90 seconds. Results: A 5-year follow-up study was completed for all the 100 patients. Fifty-one patients (51%) were 65 years of age or above. Ninety-four patients (94%) were immediately relieved of their neuralgia after the procedure. Three patients had postoperative cheek hematoma. Thirty-three patients developed herpes simplex perioralis after the operation. Two patients had transient 6th nerve palsy, which subsided within 3 months. There were no major surgical complications, no anesthetic complications and no death. No pain recurred within 3 months. Thirteen patients (13.8%) had recurrent symptoms within 2 years. Fifteen patients (16%) had recurrent symptoms within 3 years. In all, 27 patients (28.7%) had recurrent symptoms over the entire 5-year study period. Conclusions: PTGC is a technically simple, relatively noninvasive procedure that can be carried out under brief general anesthesia. The patients can tolerate well the treatment. The procedure, at present, is the first choice for those trigeminal neuralgia patients who are poor medical risks, who are above the age of 65, and who are unwilling to accept the risk of a posterior fossa craniectomy.