目的探索一种引导下经皮颧弓下人路圆孔穿刺技术,为高选择性三叉神经第Ⅱ支射频热凝治疗提供新的途径。方法取已锯开顶骨的成年人颅骨标本1具,用22号射频穿刺针选择最佳角度从面颅沿颧弓下入路接近圆孔外口,将针尖沿圆孔管送达圆孔内口,用对带穿刺针的颅骨标本进行扫描,建立圆孔穿刺的入路标志影像。扫描21例原发性三叉神经第Ⅱ支疼痛患者的患侧圆孔,并在引导下经皮颧弓下入路穿刺进入圆孔,按常规射频技术对三又神经第Ⅱ支进行射频热凝治疗,观察感觉减退范围及疗效,以射频治疗后疼痛完全消失为疗效满意。结果由穿刺针和颅骨标本配合可建立经皮圆孔穿刺的标准影像图,可用于指引引导下经皮颧弓下人路圆孔穿刺技术的建立。对21例三叉神经第Ⅱ支疼痛患者应用该技术进行穿刺,均可成功进入圆孔,实现了对神经的超选并进行射频治疗。术后随访1周至12个月,平均(7.0±2.4)个月,患者疗效满意且无复发。结论引导下经皮颧弓下入路圆孔穿刺技术,可为三叉神经第Ⅱ支疼痛患者实施高选择性射频热凝提供新的人路途径。
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