Color Doppler ultrasound guidance combined with CT 3D reconstruction of trigeminal nerve pain under the hole puncture radiofrequency coagulation surgery 1 case

1Case informationpatient, female, 53 years old, due to the right side of the face spat outside the exgestic shock-like pain 15 to my hospitalThe patient was admitted to the local hospital before admission, and after 1 week of oral kamasipine (1 tablet/day) appeared dizziness and vomitingAfter the patient went to our hospital, check the body: consciousness clear, right face mouth mouth above the mouth area pain positive, VAS pain score of 9 points, trigger point for the right nasal lip ditch near the nasal column, pain burst, each seizure time of less than 1 minute, the patient can induce pain when brushing or eatingAn MRI on the head did not show intracranial occupaposition lesionsThe patientdiagnosedis primary trigeminal nerve pain (second right)the second day of admission, the patient's head line thin layer CT (0.625mm) scan, 3DCT 3D reconstruction image shows: the right side of the bottom hole walking direction is due to the downward, from the inside to the outside (Figure 1A)The 3DCT 3D reconstruction measurement shows the angle of the angle between the lower hole and face angle on the right side: the sacropic position is 39.7 degrees (Figure 1B) and the shaft position is 35.6 degrees (Figure 1C)On the third day after the patient was admitted to hospital, the line color Doppler ultrasound (M9 color Doppler ultrasounddiagnosticinstrument, Mindray, Shenzhen, China) guided the trigeminal pain pore radiofrequency coagulation surgeryDuring the operation, the patient took the neck reclining position and used color Doppler ultrasound to determine the position between the artery and veins in the lower hole as a puncture target (Figure 1D)Figure 1 3DCT reconstruction image of the skull under the preoperative cranial hole and the image of the puncture positioning image of the underhole of the color Doppler ultrasonic guide in surgery A:3DCT reconstruction image shows lower hole (arrow pointing to right hole); B:3DCT reconstruction image shows shaft piercing direction angle of 35.6 degrees; C:3DCT reconstruction image shows sagited piercing direction angle of 39.7 degrees ;D: color Doppler ultrasound image display The puncture target is the position between the artery and the veins in the underlying hole (the white long arrow points to the artery position in the underlying hole, the white short arrow points to the venous position in the underlying hole, the black arrow points to the puncture target) the sacrotum and axial data of the 3DCT 3D reconstruction image is pierced into the needle Color super confirmed the puncture needle to reach the lower hole and the lower tube, while the patient appears face obvious pain Connecting the radio frequency meter to give sensory stimulation (50Hz, 1ms) and motion stimulation (2Hz, 1ms), electrophysiologically confirmed that the needle tip is located in the position of the mouth angle above the lip above the mouth lip of the second right face of the control trigeminal nerve, and the test range covers the patient's original pain area Electrophysiological sensory test voltage is 0.1V, motion test voltage 1.0V Give intravenous full intoxication, and give 75Degrees c of thermal coagulation radio frequency damage 120 seconds 1 time after the patient's consciousness has disappeared After surgery, the open mouth of the patient was observed without restriction, and there was no abnormality in the eye movement The vas pain in the postoperative patient disappeared and follow-up for 18 months confirmed that the pain did not recur 2 Discussion At present, radiofrequency thermocoagulation therapy instrument is mostly used for the hot coagulation treatment of trigeminal trigeminal nerve pain through the egg round hole For patients with shorter trigeminal nerve pain, radiofrequency coagulation therapy for the peripheral trigeminal branch has also been reported in the literature In the treatment of trigeminal peripheral ext radiofrequency coagulation, the puncture surgery for the second branch of the trigeminal nerve, because the puncture needle not only needs to enter the underhole, but also needs to enter the second branch of the trigeminal nerve in the lower tube, so the operation of the operation has a higher requirement Previous literature reports: The use of 3DCT reconstruction method before surgery can effectively improve the accuracy of trigeminal nerve pain round hole puncture In the treatment of the radiofrequency thermocoagulation of the underhole puncture in this case, we used the skull 3DCT reconstruction method before surgery to observe the position of the lower hole, and determined the puncture angle of the direction of the shaft and the sadular position during the puncture In the operation, we also use color Doppler color ultrasound guidance, according to the location of the artery and veins in the underlying hole, to determine the second puncture target of the trigeminal nerve We have used a variety of auxiliary techniques before and during surgery to locate, so that the operation reached a puncture success Postoperative follow-up confirmed that the patient had a good prognosis Color Doppler ultrasound-guided combination of preoperative 3DCT 3DCT reconstruction can provide greater help to the success of trigeminal nerve pain underthefore puncture radiofrequency coagulation surgery