경피적 고주파 신경근절단술에 의한 삼차신경통의 치료

Abstract

[한글]

삼차신경통 환자의 외과적치료에 대한 더욱 효과적인 방법을 강구하기 위하여 1973년 1월부터 1981년 12월까지 연세의료원 신경외과에 입원하여 경피적 고주파 삼차신경근절단술을 받은 53명의 환자에 대하여 임상분석을 시행하여 다음과 같은 결과를 얻었다.

1. 연령분포는 총 53령 중 50 및 60대가 각자 16예(30.2%)로 가장 많았으며 40대 9예(17.0%), 70대 7예(13.2%). 30대 5예( 9.4 % )의 순이였고, 성별분포는 남자가 22예 여자가 31예로 남여의 비율은 1 : 1.4였다.

2. 병력기간은 최단 3개월에서 최장 40년으로 평균 6.4년이었다.

3. 동통의 분지별 분포범위는 주로 상악 및 하악지였으며, 우측 29예(54.7%), 좌측 24예(45.3%)로 우측 대 좌측의 비율은 1.2: 1이였다. 동통유발점은 31예 (58.3%)에서 볼 수 있었다.

4. Hartel의 전방경유법을 이용하여 고주파 전류로 삼차신경근을 응고시켰으며 수술결과는 1차 수술에서 45예(84.9%), 그리고 2차 수술을 시행한 6예 중 5예에서 제통이 가능하여 총50예 (94.3%)에서 통증이 완전히 해소되었다. 1차 수술 후 부분적으로 제통이 가

능하였던 2예를 포함시키면 결국 52예 (98.1%)1에서 1차 혹은 2차 수술 후 통증이 완전히 해소되거나 호전되었다.

5. 수술 후 입원기간은 평균 2.4일이었다.

6. 수술후 6개월이상 6.5년까지 원격추적이 가능하였던 환자는 30예로서 이들에서 볼 수 있었던 후유증은 간헐적인 각막염이 4예(13.5%), 동통성 이상감각증(Painful dysesthesia)이 3예(10%)에서 있었다.

7. 원격추적결과 재발율은 첫 1년에 3예(10%), 2년 이내에 6예(20%), 4년 이내에 9예 (30%), 그리고 6,5년 이내에 10예 (33.3%)였다

8. 재발한 10예중 5예에서 경피적 고주파 신경근절단술을 재차 시행하여 5예 모두에서 통증이 완전히 해소되었다.

9.수술후 심한 지각장애는 동통성 이상감각증의 발현과 밀접한 관계가 있었으나 재발율과 수술후의 통각소실 정도와는 무관하였다.

이상의 결과를 종합하여 볼 때 경피적 고주파 삼차신경근절단술은 간편하고 안전하며 효과적으로 삼차신경통을 치료할 수 있고 재발한 경우에도 쉽게 반복 시술하여 좋은 결과를 얻을 수 있는 방법임을 확인할 수 있었고, 또한 동통부위는 반드시 무통각(analgesia)

상태로 만들어야만 하는 것은 아니고 저통각(hypalgesia)상태로 만드는 것이 이상적이었음을 알 수 있었다.

Percutaneous Radiofrequency Rhizotomy in the Treatment of Trigeminal Neuralgia

Byung Yearn Choi

Department of Medical Science The Graduate School Yonsei University

(Directed by Assoc. Prof. Sang Sup Chung, M.D.)

The author studied 53 cases of typical trigeminal neuraliga admitted to the

Department of Neurosurgery, Yonsei University Medical Center from January 1973 to

December 1981. All of the cases were treated with percutaneous radiofrequency

rhizotomy of trigeminal nerve root. In order to evaluate the effectiveness of the

treatment of the trigeminal neuralgia, the results of the radiofrequency trigeminal

rhizotomy were reviewed and sumarized as follows :

1. Higher incidence was noted in the sixth and seventh decades. The patients

consisted of 22 males and 31 females.

2. The duration of symptoms ranged from 3 months to 40 years and the average was

6.4 years.

3. The site of neuralgic pain was maxillary and/or mandibular divisions of the

trigeminal nerve in most of the cases. Involvement of the right side was noted to

be slightly higher than of the left side. Trigger zone was found in 31 cases

(58.3%).

4. The electrode was inserted into the foramen ovale by Hartel`s method and the

trigeminal nerve root was coagulated with the radiofrequency current. Complete

relief of the pain was achieved in 45 cases(84.9%) after the first operation and in

50 cases(94.3%) after the second. Two cases had partial relief of the pain.

Overall improvement of the pain was achieved in 52 cases (98.1%).

5. The mean duration of hospitalization was 2.4 days.

6. Thirty patients were followed up from 6 months to 6.5 years and main

comlications were keratitis in 13.3% and painful dysesthesia in 10% of the cases.

7. Recurrence rate was 10% within the first year after radiofrequency rhizotomy,

20% in the second year, 30% in the fourth year, and 33.3% in the 6.5th year.

8. In 5 out of 10 recurrent cases, repeated procedures resulted in complete pain

relief.

9. There was a good correlation between the postoperative anesthesia and late

occurrence of the painful dysesthesia, but there was no correlation between the

dagree of hypalgesia immediately after the operation and resurrence of the pain.

In conclusion, radiofrequency rhizotomy of the trigeminal nerve root was a

simple, safe, and effective method of pain relief in trigeminal neuralgia, and can

be repeated easily in recurrent cases. To the contrary of conventional idea that

the relief of pain was more frequently achieved in the patients with postoperative

analgesia, the results of this study show that the rate of pain relief and

recurrence rate were not significantly different between the patients with

postoperative analgesia and those with mere hypalgesia.

[영문]

The author studied 53 cases of typical trigeminal neuraliga admitted to the Department of Neurosurgery, Yonsei University Medical Center from January 1973 to December 1981. All of the cases were treated with percutaneous radiofrequency rhizotomy of trigeminal nerve root. In order to evaluate the effectiveness of the treatment of the trigeminal neuralgia, the results of the radiofrequency trigeminal rhizotomy were reviewed and sumarized as follows :

1. Higher incidence was noted in the sixth and seventh decades. The patients consisted of 22 males and 31 females.

2. The duration of symptoms ranged from 3 months to 40 years and the average was 6.4 years.

3. The site of neuralgic pain was maxillary and/or mandibular divisions of the trigeminal nerve in most of the cases. Involvement of the right side was noted to be slightly higher than of the left side. Trigger zone was found in 31 cases

(58.3%).

4. The electrode was inserted into the foramen ovale by Hartel`s method and the trigeminal nerve root was coagulated with the radiofrequency current. Complete relief of the pain was achieved in 45 cases(84.9%) after the first operation and in

50 cases(94.3%) after the second. Two cases had partial relief of the pain.

Overall improvement of the pain was achieved in 52 cases (98.1%).

5. The mean duration of hospitalization was 2.4 days.

6. Thirty patients were followed up from 6 months to 6.5 years and main comlications were keratitis in 13.3% and painful dysesthesia in 10% of the cases.

7. Recurrence rate was 10% within the first year after radiofrequency rhizotomy, 20% in the second year, 30% in the fourth year, and 33.3% in the 6.5th year.

8. In 5 out of 10 recurrent cases, repeated procedures resulted in complete pain relief.

9. There was a good correlation between the postoperative anesthesia and late occurrence of the painful dysesthesia, but there was no correlation between the dagree of hypalgesia immediately after the operation and resurrence of the pain.

In conclusion, radiofrequency rhizotomy of the trigeminal nerve root was a simple, safe, and effective method of pain relief in trigeminal neuralgia, and can be repeated easily in recurrent cases. To the contrary of conventional idea that the relief of pain was more frequently achieved in the patients with postoperative analgesia, the results of this study show that the rate of pain relief and recurrence rate were not significantly different between the patients with postoperative analgesia and those with mere hypalgesia.