3D-Slicer 软件辅助经皮球囊压迫术治疗三叉神经痛的临床分析

doi:10.19854/j.cnki.1008-2425.2023.04.0006

摘要/Abstract

摘要： 目的探讨3D-Slicer软件进行模型重建,辅助三叉神经节经皮球囊压迫术(PBC)临床应用,为精准手术提供辅助手段。方法回顾性分析2020~2022年贵黔国际总医院神经外科 3D-Slicer软件辅助20例PBC治疗三叉神经痛患者的临床资料。术前均行薄层头颅CT和磁共振血管成像检查;术前三维重建卵圆孔大小、长度,面部皮肤,穿刺路径及深度;手术前、后的疼痛程度采用视觉模拟评分法(VAS)评估。并在术后1、3、6个月随访患者的预后情况。结果根据三维重建设计入路,均成功以最佳位置经过卵圆孔穿刺到Meckel's囊,球囊呈倒“梨形”,3D重建图像与术中实际所见基本一致。术后三叉神经痛均即刻得到缓解,VAS评分的中位数由10分 (9~10分)均降至0分,术后均未出现血管损伤、颅神经损伤、溃疡性角膜炎、感染并发症,术后均出现手术同侧面部感觉减退或麻木症状,5例出现咀嚼无力症状。患者的随访时间为1~6个月,其中13例患者于术后3个月随访时面部麻木症状减轻;5例患者在术后6个月随访时其症状有所减轻。末次随访显示,20例患者的VAS疼痛评分仍为0分,均无疼痛复发现象。结论 3D-Slicer软件为PBC提供客观、准确定位,帮助理解卵圆孔位置、形态,避免手术路径偏航,有穿刺准确、节省时间、并发症少、安全性高的优点,有重要的临床应用意义。

关键词: 3D-Slicer软件, 三叉神经痛,三叉神经节经皮球囊压迫术

Abstract: Objective To explore the clinical application of 3D-Slicer software in model reconstruction and assisting trigeminal ganglion percutaneous balloon compression(PBC),so as to provide a better auxiliary means for accurate surgery.Methods A retrospective analysis was conducted clinical data of 20patientswithtrigeminalneuralgia treated by PBC assisted by 3D-Slicer in Neurosurgery Department of Guiqian International General Hospital from 2020 to 2022.Thin-slice cranial CT and magnetic resonance angiography were performed before surgery.3D-Slicer software was used to reconstruct the size,lengthof foramen ovale,facial skin,puncture path and depth before surgery.Visual analog scale (VAS) was used to evaluate the pain before and after surgery.The prognosis of patients was followed up at 1,3 and 6 months after surgery.Results The surgical approach designed according to the results of 3D reconstruction was successful in all cases.Meckel's capsule was punctured through ovale foramen in the optimal position,and the balloon was inverted “pear shape”.The 3D reconstruction image was basically consistent with the actual intraoperative observation.Trigeminal neuralgia was relieved immediately after surgery,and the median VAS score decreased from 10 points (9-10 points) to 0 points.No vascular injury,cranial nerve palsy,ulcerative keratitis,or infection complications occurred after surgery,but all patients showed symptoms of hypoesthesia or numbness in the same side of the surgery,and 5 patients showed symptoms of masticatory weakness.The patients were followed up for 1-6 months,and 13 patients showed relief of facial numbness at 3 months after the operation.The symptoms of 5 patients were alleviated at 6 months after the operation.The last follow-up showed that the VAS score of 20 patients was still 0,and no pain occurred.Conclusion 3D-Slicer software can provide objective and accurate positioning for PBC,help understand the position and shape of foramen ovalis,and avoid surgical path deviation.It has the advantages of accurate puncture,saving time,fewer complications and high safety,and has important clinical application significance.

Key words: 3D-Slicer software, Trigeminal neuralgia, Percutaneous balloon compression

中图分类号:

R745.1⁺1

黄绍宽, 迟乃新, 宋俊良, 施飞亚, 田军, 黄其林. 3D-Slicer 软件辅助经皮球囊压迫术治疗三叉神经痛的临床分析[J]. 立体定向和功能性神经外科杂志, 2023, 36(4): 223-227.

Huang Shaokuan, Chi Naixin, Song Junliang, et al. Clinical analysis of 3D-Slicer software assisted percutaneous balloon compression in treatment of trigeminal neuralgia[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2023, 36(4): 223-227.

参考文献

[1] Alshkry A,Salburgo F,Jaloux L,et al.Trigeminal neuralgia(TN):A descriptive literature analysis on the diagnosis and management modalities[J].J Stomatol Oral Maxillofac Surg,2017,118(4):251~254.
[2] Mcmillan R.Trigeminal neuralgia - a debilitating facial pain[J].Rev Pain,2011,5(1):26~34.
[3] AydoseliA,Akcakaya MO,Aras Y,et al.Neuronavigationassisted percutaneous balloon compression for the treatment oftrigeminal neuralgia: the technique and short-term clinical results[J].Br J Neurosurg,2015,29(4) :552~558.
[4] 马逸,李岩峰,史万超.经皮穿刺微球囊压迫治疗三叉神经痛[J].中国微侵袭神经外科杂志,2002,7(4):208~209.
[5] Sterman-Neto H,Fukuda CY,Duarte KP,et al.Balloon compression vs radiofrequency for primary trigeminal neuralgia:arandomized,controlled trial[J].Pain,2021,162(3):919~929.
[6] 梁晓龙.经皮微球囊压迫家兔三叉神经半月节后组织学与乙酰胆碱酯酶的改变[D].杭州:浙江中医药大学,2016.
[7] 黄海韬,李岩峰,吴玉鹏,等.经皮微球囊压迫术治疗家兔三叉神经痛的组织学研究[J].中华神经外科疾病研究杂志,2018,17(6):508~511.
[8] Park SS,Lee MK,Kim JW,et al.Percutaneous balloon compression oftrigeminal ganglion forthetreatment of idiopathictrigeminal neuralgia:experience in 50 patients[J].J KoreanNeurosurg Soc,2008,43(4):186~189.
[9] Ji-Gang Chen Khdz.Presurgical planning for supratentorial lesions with free slicer software and sina app[J].World Neurosurg,2017,106:193~197.
[10] Pietro N,Alexander J,Conor OS,et al.Pre-clinical validation of virtual bronchoscopy using 3D Slicer[J].Int J Comput Assist Radiol Surg,2017,12(1):25~38.
[11] Bruns N.3D Slicer :Universal 3D visualization software[J].Un - fallchirurg,2019,122(8):662.
[12] Qin Q,Wang Y.Recurrent trigeminocardiac reflex in percutaneous balloon compression for trigeminal neuralgia:a casereport[J].Medicine (Baltimore),2020,99(44):e22467.
[13] Sodickson A,Baeyens PF,Andriole KP,et al.Recurrent CT,cumulative radiation exposure,and associated radiation-inducedcancer risks from CT of adults[J].Radiology,2009,251 (1):175~184.
[14] Noorani I,Lodge A,Vajramani G,et al.The effectiveness ofpercutaneous balloon compression,thermocoagulation,and glycerol rhizolysis for trigeminal neuralgia in multiple sclerosis[J].Neurosurgery,2019,85(4):E684~E692.
[15] Sun C,Zheng W,Zhu Q,et al.The Transformation of the balloonshape in percutaneous balloon compression for trigeminalneuralgia[J].J Pain Res,2021,14:3805~3814.
[16] Wang Q,Chen C,Guo G,et al.A prospective study to examine the association of the foramen ovale size with intraluminal pressure of pear-shaped balloon in percutaneous balloon compression for trigeminal neuralgia[J].Pain Ther,2021,10(2):1439~1450.
[17] Xu W,Jiang C,Yu C,et al.Percutaneous balloon compression forpersistent or recurrent trigeminal neuralgia after microvasculardecompression:personal experience of 28 patients[J].Acta NeurolBelg,2018,118(4):561~566.
[18] Mendes PD,Martins da Cunha PH,Monteiro K,et al.Percutaneousforamen ovale puncture:usefulness ofintraoperative CT control,in the eventuality of a narrow foramen[J].Stereotact Fund Neurosurg,2021,99(1):75~78.
[19] Van Gompel JJ, Kallmes DF,Morris JM, et al.Dyna-CT as an imaging adjunct to routine percutaneous balloon compression for trigeminal neuralgia[J].Stereotact Fund Neurosurg,2009,87(5) :330~333.
[20] Montano N,Gaudino S,Giordano C,et al.Possible prognostic roleof magnetic resonance imaging findings in patients with trigeminalneuralgia and multiple sclerosiswho underwent percutaneousballoon compression:report of our series and literature review[J].World Neurosurg,2019,125:e575~e581.
[21] Wang H,Chen C,Chen D,et al.Clinical analysis of the treatmentof primary trigeminal neuralgia by percutaneous ballooncompression[J].Front Surg,2022,9:843982.
[22] Irhida MC,de Almeida AN,da Nohrega JC,et al.Sensory abnormalities and masticatory function after microvascular decompression or balloon compression for trigeminal neuralgia compared with carbamazepine and healthy controls[J].Neurosurg,2015,122(6) :1315~1323.
[23] Fan X,Xu F,Ren H,et al.The analysis of percutaneous ballooncompression on efficacy and negative emotion in the treatment ofrecurrent trigeminal neuralgia after surgical procedures[J].PainPhysician,2021,24(8):E1255~E1262.
[24] G(')rdoba JL,Garcia Bach M,1'sach IN,et al.Perrutaneousballoon compression for trigeminal neuralgia:imaging andtechnical aspects[J].Reg Anesth Pain Med,2015,40(5):616~622.
[25] Agazzi S,Chang S,Drucker MD,et al.Sudden blindness as acomplication of percutaneous trigeminal procedures:mechanismanalysis and prevention[J].Neurosurg,2009,110(4):638~641.
[26] Lv W,Hu W,Chi L,et al.Factors that may delay disappearanceof trigeminal neuralgia after percutaneous balloon compression[J].Neurol Neurochir Pol,2022,56(2):156~162.