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Chemical mutilation of trigeminal gasserian ganglion following CT-guided percutaneous puncture for the treatment of severe trigeminal neuralgia

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机构: [1]首都医科大学宣武医院疼痛诊疗中心,北京市 [2]河北医科大学第二医院CT室, 河北省石家庄市 [3]河北医科大学第二医院麻醉科, 河北省石家庄市
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Aim: To investigate the effects of chemical mutilation of trigeminal gasserian ganglion after percutaneous puncture guided by computerized tomography(CT) in treating severe trigeminal neuralgia. Methods: Seventy-six patients suffering from severe trigeminal neuralgia were treated by chemical mutilation of trigeminal gasserian ganglion following percutaneous puncture guided by CT in the Center for Diagnosis and Treatment of Pain, Xuanwu Hospital, Capital University of Medical Sciences from March 1994 to December 2001. Before treatment, oval foramens were checked by coral and axil CT scan in order to exclude the secondary trigeminal neuralgia. The CT scan showed the direction of needle and the location of needle tip during the percutaneous puncture of oval foramens. Adriamycin was injected into trigeminal gasserian ganglion as a neurolytic agent after the identification when contrast medium spread properly inside the ganglion on CT monitor. The score of visual analogue scale(VAS), quality of life(QOL) and complications were recorded at 0, 7 days, 6 and 12 months after treatment. 1 The score of VAS: 0 mark as be painless, 10 marks as twinge; 1 to 3 marks as mild pain, 4 to 6 marks as moderate pain, 1 to 10 severe pain. 2 Degree of pain relief. The grading standard of number 0 to 4 pain relief was adopted. Grade 0: unrelieved pain(pain was not relieved), grade 1: mildly relieved pain (pain was relieved by about 1/4), grade 2: moderately relieved pain(pain was relieved by about 1/2), grade 3: remarkably relieved pain(pain was relieved by over 3/4), grade 4: completely relieved pain (pain disappeared). 3 Score of QOL: Self-evaluation was performed concerning impact of pain on the appetite, sleep, daily life, mental status, emotion, interpersonal relationship, living interest in patients, manifesting as 0 to 10 marks, 0 as no influence and 10 marks as the most influence. Results: According to the actual management, all the patients finished the puncture and chemical treatment successfully except one failed in dissection due to dissociation. 1 The score of VAS before and after treatment: The score of VAS was significantly higher before treatment than after treatment[(8.7±2.7) marks before treatment, (1.6±2.1) marks at 7 days after treatment, (2.1±0.9) marks at 6 months after treatment, (2.32±0.7) marks at 12 months after treatment, P < 0.01]. 2 Relief of pain after treatment: By the 7th day after treatment the neuralgia disappeared in 61 cases and improved in 11 cases, and unrelieved in 4; In the 4 pain-unrelieved patients, 2 were treated by neurosurgery instead. After 12-month treatment, the neuralgia disappeared in 58 patients and unrelieved in 11. 3 The score of QOL after treatment: The score of appetite, sleep, daily life, mental status, emotion, interpersonal relationship, living interest was significantly higher before treatment than after treatment[(5.7 ± 2.8), (4.0 ± 2.0), (6.1 ± 2.4), (6.1 ± 2.4), (6.9 ± 2.3) marks respectively before treatment, (2.5 ± 1.5), (2.8 ± 1.2), (3.5 ± 2.3), (2.6 ± 1.6), (4.8 ± 2.3) marks at 7 days after treatment; (2.9 ± 1.3), (2.0 ± 0.7), (2.5 ± 1.2), (3.1 ± 1.5), (2.4 ± 1.1) marks at 6 months after treatment, (2.2 ± 1.1), (1.8 ± 1.1), (2.3 ± 1.6), (2.1 ± 0.9), (1.8 ± 1.0) marks at 12 months after treatment, P < 0.05 or 0.01]. Conclusion: Chemical mutilation of trigeminal gasserian ganglion following percutaneous puncture guided by CT can improve severe trigeminal neuralgia obviously. By the guidance of CT for trigeminal gasserian ganglion, the location can be identified exactly and the therapeutic effect is better. Attributing to local anesthesia, the above procedure is less pain for patients and causes less complication.

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通讯机构: [1]首都医科大学宣武医院疼痛诊疗中心,北京市
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