Meckel's腔形狀與PBC術中球囊形狀、壓力關系的研究

【中圖分類號】 R651 【文獻標志碼】 B 【文章編號】1672-7770（2025）02-0205-05

Abstract：ObjectiveTo investigate therelationship between Meckel'scavityshape，baloonshapeand intracapsular pressure during percutaneous baloon compresion（PBC）.MethodsFifty-eight patientswith typical trigeminal neuralgia who underwent PBC in Afiliated University from September 2O20 February 2022 were analyzed retrospectively.Magnetic resonance imaging （MRI）3D-FIESTA thin-layer scanning sequence reconstruction was performed before operation analyze thesagittal features Meckel’s cave.The pressure when ballon“pear shaped” forming wasrecorded continuously during operation，and the baloon height/length ratio was measured.Therelationship betweenthe shape the Meckel's cave cavity，theshapetheballoon，andthe internalpressurewithinthe ballonwasanalyzedthrough multiple parameters.ResultsThepain 57 patients was relieved immediatelyafter operation，andtheefective rate was 98.28% .Recurrence occurred in 2 cases and the recurrence rate was 3.5% with the 7.5 months median following time.Classification Meckel’s cave on magnetic resonance imaging showed the clubbing type accounted for （31.1%） ，oval type（58.6%），flat type（10.3%） .Theintracavitarypressurewas significantlynegativelycorrelated withtheheight/lengthratio Meckel’scave.There wasnostatisticallysignificant differencebetween theheight/ lengthratiothebaloonandthat Meckel’scave.ConclusionsPreoperativeevaluation thesagital shape Meckel's caveis conducted using 3D-FIESTAthin-slice MRIreconstruction.The results indicateanegative correlation between intracavitarypressureandthe height/lengthratioMeckel’scave.However，thecorrelation between the“pear shaped”balloon formationand the sagittal shape Meckel's cave is relatively low.

Key words： trigeminal neuralgia；percutaneous ballon compression； Meckel's cave；“pear shaped”balloon三叉神經支配區域內突然出現短暫、反復發作的針刺樣劇烈疼痛，發病率為 12.6/10 萬＼～27/10萬，嚴重影響患者的健康狀況和生活質量。當保守治療無法有效控制疼痛時，可考慮進行手術干預。約 75% 的三叉神經痛患者最終接受手術治療[1]。經皮球囊壓迫術（percutaneous balloon compression，PBC）因其微創、療效可靠等優勢，成為部分顯微血管減壓術（microvasculardecompression，MVD）術后復發、高齡或不能耐受開顱手術患者的較好選擇。

多項研究表明，PBC術中“梨形”球囊的形成是取得良好療效的關鍵因素[2-5]。為提高疼痛改善率并降低顱神經麻痹風險，術中進行球囊壓力監測有助于判斷合適的三叉神經半月節壓迫程度。當球囊置于Meckels腔時，“梨形”成型后的初始囊內壓力通常與Meckel's腔外壓力不同[6]。球囊的“梨形”形狀通常被視為手術成功的重要指標。有研究表明，Meckels腔的形狀可能與三叉神經痛的發病機制相關[7]。盡管關于Meckel's腔的尸體解剖研究較多，但通過磁共振研究三叉神經痛患者Meckel's腔解剖的研究較少。此外，Meckel's腔的形狀與術中形成的“梨形”具體形狀及囊內壓力之間的關系尚不明確。本研究回顧性分析2020年9月—2022年2月在南京醫科大學附屬腦科醫院接受PBC手術治療的58例典型三叉神經痛患者，旨在通過術前3D-FIESTA薄層掃描序列重建分析Meckel's腔矢狀位的特征，以評估其與PBC術中“梨形”成型及球囊內壓力的關系。

1資料與方法

1.1一般資料共納入58例典型三叉神經痛患者，其中男24例，女34例；平均年齡（ 72±23 ）歲；病程6＼～360個月，平均病程70個月（表1）。納入標準：（1）明確診斷為原發性三叉神經痛，頭顱核磁共振成像（magnetic resonance imaging，MRI）神經血管成像提示有血管壓迫或神經血管關系密切；……