摘要
目的研究三叉神经的解剖及多模态影像融合,以期为三叉神经痛的临床微创介入治疗策略提供依据。方法解剖三叉神经大体结构及其与毗邻结构的位置关系,并分别用计算机体层摄影术和核磁共振成像术对三叉神经进行成像,然后进行CT/MRI图像融合。结果三叉神经半月节位于颅中窝硬脑膜外的Meckel腔内,节内三大分支神经纤维交织。CT只能清晰显示半月节毗邻的骨性结构而不能显示在体半月神经节,MRI正好相反,骨性结构显影模糊,但对三叉神经半月节所在Meckel囊和神经根均能清晰分辨,将CT/MRI图像融合即可使二者优势互补。结论基于三叉神经的解剖结构和位置,在半月节射频较难实现对三叉神经痛进行高选择性分支治疗;对三叉神经半月节球囊压迫治疗时,球囊导管应位于Meckel腔内,但不必置入Meckel囊,且球囊导管放置深度以远端平齐颞骨岩锥顶端为宜。
Objective To study the anatomy and multimodal image fusion of the trigeminal nerve,in order to provide a basis for clinical minimally invasive interventional treatment strategies for trigeminal neuralgia.Methods Dissected the general structure of the trigeminal nerve and its positional relationship with adjacent structures,and used computed tomography and MRI to image the trigeminal nerve,and then performed CT/MRI image fusion.Results The Gasserian-ganglion of the trigeminal nerve was located in the Meckel's cavity,outside the dura of the middle cranial fossa,and the three branches of the nerve fibers were intertwined.CT can only clearly show the bony structures adjacent to the Gasserian-ganglion but not the Gasserian-ganglion in the body.MRI was just the opposite.The bony structure was blurred,but the Meckel's capsule and nerve roots where the trigeminal nerve was located can be clearly distinguished.CT/MRI image fusion can make the two advantages complementary.Conclusions Based on the anatomical structure and position of the trigeminal nerve,it is difficult to achieve highly selective branch treatment of trigeminal neuralgia with radiofrequency in the Gasserian-ganglion;For the treatment of trigeminal neuralgia with percutaneous microballoon compression on the Gasserian-ganglion,the balloon catheter should be placed into the Meckel's cave,but it is not necessary to insert into the Meckel's capsule,and the depth of the balloon catheter should be that the distal end is flush with the top of the temporal bone petrous cone.
作者
黄冰
王晓明
祝则峰
杜鑫丹
林慧丹
曹刚
姚明
Huang Bing;Wang Xiaoming;Zhu Zefeng;Du Xindan;Lin Huidan;Cao Gang;Yao Ming(Department of Pain Medicine,the Affiliated Hospital of Jiaxing University,Jiaxing City,Zhejiang Province 314000,China;Department of Pain Medicine,Hangzhou Red Cross Hospital,Hangzhou City,Zhejiang Province 310006,China;Department of Pain Medicine,the First Hospital of Ningbo,Ningbo City,Zhejiang Province 312000,China)
出处
《中华疼痛学杂志》
2021年第1期75-82,共8页
Chinese Journal Of Painology
基金
浙江省医药卫生平台重点项目(2016ZDA018)
浙江省医药卫生科技计划项目(2019ZH046、2019KY605)
嘉兴市重点科技项目(2018AY32010)。
