Computed tomography-guided percutaneous radiofrequency thermocoagulation for primary trigeminal neuralgia in older and younger patients

We evaluated the immediate and long-term clinical efficacy of computed tomography （CT）-guided radiofrequency thermocoagulation for primary trigeminal neuralgia （RTPTN） in 852 patients including 502 patients aged -〉 60 years and 350 patients aged 〈 60 years. After discharge, the incidence of complications was 1.0% and 0.9% in patients aged 〉 60 years and patients aged 〈 60 years, respectively. Over 3-year follow-up after CT-guided RTPTN, 96.8% of the patients aged 〉 60 years and 98.6% of the patients aged 〈 60 years were completely pain-free, and there was no significant difference between these two age brackets. In addition, there were no significant differences in quality of life scores and numbness scores between these two age brackets. These findings suggest that CT-guided RTPTN is a safe and effective method and is recommended for older and poor-risk patients.

Treatment of Popliteal Cyst through Radiofrequency Thermocoagulation under Ultrasound Guidance

Objective: The purpose of this study was to explore the clinical efficacy and security of the treatment of popliteal cyst through radiofrequency thermocoagulation (RFT) under ultrasound guidance. Methods: The clinical data of 35 patients with popliteal cyst, who were treated by RFT under ultrasound guidance from June 2019 to June 2020, were retrospectively analyzed. The Visual Analogue Scores (VAS) and the size of cyst before and after treatment were recorded at the first month, the third month, the sixth month. After six months, the recovery rate of Rauschning and Lindgren classification (R-L classification) level 0, 0 - I were counted. All the complications of the patients were observed. Results: 32 patients were followed up for six months. The scores and cyst sizes of each patient before and after the treatment were on a normal distribution curve. There was no significant difference in VAS scores before and after the treatment (P > 0.05). However, there was a significant difference in cyst sizes before and after the treatment (P < 0.05). Moreover, there was no significant difference in VAS scores and cyst sizes in each period after treatment (P > 0.05). According to the R-L classification in 6 months after treatment: the recovery rate of class 0 was 62.5% and class 0 - I level was 87.5%. There were no serious complications in the process. Conclusion: Treatment of popliteal cyst through RFT under ultrasound guidance is a simple, easy, reliable method that is worthy of clinical promotion.

Effect of percutaneous radiofrequency thermocoagulation on different neuropathic pains

BACKGROUND: The clinical treatment of neuropathic pain is very troublesome, and the physical method of radiofrequency thermocoagulation is a good choice for its treatment. OBJECTIVE: To observe the curative effect of percutaneous radiofrequency thermocoagulation on neuropathic neuralgia. DESIGN: A case follow-up analysis. SETTING: Minimally Invasive Surgery Room, Department of Neurosurgery, Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA. PARTICIPANTS: Totally 131 patients were selected from the Department of Neurosurgery, Urumqi General Hospital of Lanzhou Military Area Command of Chinese PLA from December 2000 to June 2006, including 73 males and 58 females, aging 37-72 years old, AND the disease course was 2-15 years. ① Drug treatment failed to alleviate the pain or induced obvious side effects; ② With the same pathological changes as pain and effective in the nerve block test; Had signed the informed consents before treatment. Distribution of the neuropathic pain: ① Trigeminal neuralgia, which were lighting attack, located at V2 in 28 cases, V3 in 46 cases, V1+V2 in 3 cases, V2+V3 in 28 cases, and V1+V2+V3 in 1 case; ② Migraine located at (except the frontal branch of trigeminal nerve) greater and lesser occipital nerves in 6 cases, auriculotemporal nerve in 3 cases, temporal and zygomatic nerves in 3 cases; ③ Unilateral neuralgia of C2 and C3 following herpes zoster in 1 case, and chest intercostals neuralgia in 2 cases; ④ Lasting burning pain in the operative area after thoracotomy was in 1 case of lung cancer. METHODS: ① All the enrolled patients were treated with percutaneous puncture at trigeminal ganglion or peripheral nerve, then nerve block was performed firstly for anesthesia, and the pain disappeared immediately at this moment, there was hypoesthesia or numbness in the area of innervation, which manifested the puncture apposition was correct, then electrostimulation of 50 Hz with the current of 0.1-0.5 V was given for further functional localization. ② The RFG-3C radiofrequency therapeutic instrument (Radionics, USA) was used, the tip of the radiofrequency electrode was exposed for 5 mm, the temperature was kept at 80-85 ℃, 30-60 for each time, and treated for 3 or 4 times. The neuralgia following herpes zoster could also be treated by thermocoagulation at several points. ③ Evaluation standards for the therapeutic efficacy: Excellent meant the pain disappeared completely without taking any anodyne. Good referred to the pain was alleviated as compared with the preoperative one, and it could be effectively controlled by anodyne at relapse, but radiofrequency therapy was unnecessary. MAIN OUTCOME MEASURES: Therapeutic efficacy of neuropathic neuralgia of different types after treatment of percutaneous radiofrequency thermocoagulation. RESULTS: All the 131 patients were involved in the final analysis of results, no one missed. ① Therapeutic efficacy: In the 24-month follow-up, the therapeutic efficacy was excellent in 106 cases (80.9%), good in 21 cases (16.0 %) and had no change in 4 cases (3.1%). For 13 of the patients with trigeminal neuralgia, the pain relapsed after the lesion of peripheral branches, and it disappeared after the second treatment. The treatment was invalid for 1 patient with lung cancer suffering from pain in the operative area after thoracotomy, and the pain was alleviated by spinal cord stimulation. The pain disappeared after treated for 3 times in the patients with cervical neuralgia following herpes zoster. ② The pain relapsed in 28 cases (21.4%) at 12 months of the follow-up. ③ Adverse events and side effects: Except the hypoesthesia of different severity at the site of pain, there was no other complication after treatment. CONCLUSION:The follow-up results showed that percutaneous radiofrequency thermocoagulation is one of the effective methods for treating neuropathic neuralgias of various types.

Chinese Association for the Study of Pain:Expert consensus on diagnosis and treatment for lumbar disc herniation

Lumbar disc herniation is a common disease in the clinical context and does great harm to either the physical or mental health of patients suffering from this disease.Many guidelines and consensus for the diagnosis and treatment of lumbar disc herniation have been published domestically and internationally.According to the expert consensus,clinicians could adopt tailored and personalized diagnosis and treatment management strategies for lumbar disc herniation patients.

Radiofrequency thermocoagulation rhizotomy for recurrent trigeminal neuralgia after microvascular decompression

Background Microvascular decompression （MVD） is a well accepted surgical treatment strategy for trigeminal neuralgia （TN） with satisfying long-term outcome. However, considerable recurrent patients need more effective management. The purpose of this study was to evaluate the effectiveness of radiofrequency thermocoagulation rhizotomy （RTR） on patients with recurrent TN after MVD. Methods Totally 62 cases of recurrent TN after MVD undergoing RTR from January 2000 to January 2010 were retrospectively evaluated. Based on surgical procedures undertaken, these 62 cases were classified into two subgroups： group A consisted of 23 cases that underwent traditional RTR by free-hand; group B consisted of 39 cases that underwent RTR under the guidance of virtual reality imaging technique or neuronavigation system. The patients in group A were followed up for 14 to 70 months （mean, 40±4）, and those in group B were followed up for 13 to 65 months （mean, 46±7）. Kaplan-Meier analyses of the pain-free survival curves were used for the censored survival data, and the log-rank test was used to compare survival curves of the two groups. Results All patients in both groups A and B attained immediate pain relief after RTR. Both groups attained good pain relief rate within the first two years of follow-up： 92.3%, 84.6% and 82.6%, 69.6% respectively （P 〉0.05）. After 2 years, the virtual reality or neuronavigation assisted RTR group （group B） demonstrated higher pain relief rates of 82.5%, 76.2% and 68.8% at 3, 4 and 5 years after operation respectively, while those in group A was 57.2%, 49.6%, and 36.4% （P 〈0.05）. Low levels of minor complications were recorded, while neither mortalities nor significant morbidity was documented. Conclusions RTR was effective in alleviating the pain of TN cases suffering from unsuccessful MVD management. With the help of virtual reality imaging technique or neuronavigation system, the patients could attain better long-term pain relief.

Fluoroscopy-guided Bipolar Radiofrequency Thermocoagulation Treatment for Discogenic Low Back Pain

Background：The efficacy of percutaneous intradiscal radiofrequency thermocoagulation （PIRFT） for the treatment of discogenic low back pain （LBP） remains controversial.However,all the PIRFT studies utilized monopolar radiofrequency thermocoagulation （RFTC）.The aim of this study was to investigate the safety and efficacy of bipolar RFTC for the treatment of discogenic LBP.Methods：A total of 23 patients with discogenic LBP were treated with single-level bipolar RFTC.The patients were assessed before the procedure and at 1 week,1 month,3 months,6 months,and 1 year after the procedure.The primary outcome included the visual analog scale （VAS） score and the Oswestry Disability Index （ODI） score.The secondary outcome included pain relief,reduction of analgesic dose,and patient satisfaction.Results：The VAS and ODI scores were significantly decreased after bipolar RFTC treatment at all time points of follow-up （P 〈 0.05）.Bipolar RFTC treatment also resulted in a significant change in all secondary measures,such as pain relief,reduction of analgesic dose,and patient satisfaction.No serious complications or neurological sequelae were observed in any of the patients.Conclusions：Bipolar RFTC treatment can significantly attenuate pain and improve the function of patients with discogenic LBP.

Quantitative assessment of sensory functions after 3 surgical approaches for trigeminal neuralgia by current perception threshold measurement

Objective： To quantitatively identify and grade trigeminal sensory functions after 3 major surgical procedures of trigeminal neuralgia using a newly developed quantitative sensory testing technique, current perception threshold measurement （CPTM）. Methods： In the current study, there were 48 trigeminal neuralgia patients without history of prior surgical treatment. These patients received one of the following 3 surgical procedures, microvascular decompression （MVD）, peripheral nerve block with alcohol （PNB）, or percutaneous radiofrequency thermocoagulation （PRFT）. The quantitative sensory testing measurement, CPTM, and conventional qualitative sensory testing measurements were performed preoperatively and postoperatively to evaluate and grade the trigeminal sensory functions All 3 major cutaneous sensory fiber types, large myelinated fibers （A beta）, small myelinated fibers （A delta） and unmyelinated fibers（C） were allowed to quantitatively evaluate and grade by CPTM. The results of the measurements were statistically analyzed using a one-way analysis of variance （single factor）. Each subject was his/her own control for comparison of the preoperative to postoperative state on the asymptomatic and symptomatic sides. Subjects were tested 48 h preoperatively and 4 weeks postoperatively. Results： PNB with alcohol and PRFT caused significant sensory dysfunction postoperatively in every fiber type, indicating damage to all fibers. On the contrary, the sensory function in all 3 fiber types was unchanged after MVD management. Conclusion： Among the 3 major surgical procedures tested, only MVD preserves sensory function in trigeminal system. CPTM is of quantitative nature on the evaluation of sensory functions of nerve fibers

Adult‑onset hypothalamic hamartoma:origin of epilepsy?

Background Hypothalamic hamartoma(HH)is a congenital non-progressive lesion of hypothalamus during fetal development.Mass-like lesions in different anatomical locations often develop a variously disabling course presenting with cognitive decline,psychiatric symptoms,as well as multiple seizure types.As a rare disease,HH is relatively common in infants and children,but it is extremely rare in adults.Case presentation We reported a case of adult-onset hypothalamic hamartoma,and summarized and analyzed relevant reports and studies of HH worldwide.The patient had clinical manifestations characterized by multiple seizure forms.After stereotactic radiofrequency thermocoagulation and drug treatment,the condition was effectively controlled.The patient was followed up till October 2022,with no recurrence of seizures.Conclusions Epilepsy caused by HH can resemble that of temporal lobe seizures,as HH forms a complex epileptogenic network with other regions of the brain through anatomical and functional connections.Early treatment of HH can provide better control of the symptoms of epilepsy,and patients with longer disease courses may have more complications.