Yuanzhang Tang

Long-term outcome of computed tomography-guided percutaneous radiofrequency thermocoagulation for classic trigeminal neuralgia patients older than 70 years.

Abstract The incidence of trigeminal neuralgia (TN) in elderly patients is higher. However, for those with poor fitness, the optimal surgical treatment for those refractory to medical treatment is controversial. The aim of current study was to investigate the long-term outcome of computed tomography (CT)–guided percutaneous radiofrequency thermocoagulation (PRT) for 304 TN patients 70 years or older. We conducted a retrospective study of 304 elderly patients with TN who were treated with CT-guided PRT between 2002 and 2012. Follow-up was censored at the time of last contact, additional surgery, or death. Sixty-seven patients (22.1%) were of more than American Society of Anesthesiologists classification system physical status II. Excellent pain relief was 100% at discharge, 85% at 1 year, 75% at 3 years, 71% at 5 years, and 49% at 10 years. Pain relief outcomes were correlated with facial numbness. Lower temperature group (⩽75°C) can attain the same long-term pain relief as higher temperature group (≥80°C); however, the incidence of painful dysesthesia rate of higher temperature group was higher than lower temperature group. Postoperative morbidity included facial numbness, masseter weakness, corneitis, hearing loss, dropping eyelid, and limited mouth opening. There were no mortalities observed during or after PRT. Our result showed CT-guided PRT is safe and effective for classic TN patients 70 years or older, including poor-fitness patients (American Society of Anesthesiologists classification system physical status >II). Lower temperature (⩽75°C) is recommended for PRT in the treatment of TN.

High-Frequency Repetitive Transcranial Magnetic Stimulation Reduces Pain in Postherpetic Neuralgia

OBJECTIVES Postherpetic neuralgia (PHN) is one of the most intractable pain disorders, especially in elderly patients. There is evidence that repetitive transcranial magnetic stimulation (rTMS) reduces neuropathic pain; however, its effectiveness for PHN is unknown. This study investigated the efficacy of high-frequency rTMS in patients with PHN. DESIGN A total of 40 patients were randomly assigned to receive 10 sessions of real or sham rTMS of the primary motor cortex. Each stimulation session consisted of a series of 300 five-second pulses with a frequency of 10 Hz and an interval of 3 seconds between each train, giving a total of 1500 pulses per session. The primary outcome was pain intensity measured before stimulation from first intervention (T0) to the final stimulation (T10), and 1 and 3 months after final stimulation (T11 and T12). Other outcomes measured included scores on the short form McGill pain questionnaire, self-rating depression scale, quality of life (QOL), sleep quality, the patient global impression of change, medication regulation, and reported adverse events. RESULTS The real rTMS group demonstrated greater reduction of visual analogue scale (VAS) than the sham group at each time point except for T0 (P = 0.399) and T1 (P = 0.091). Mean VAS reduction in the real rTMS group was 16.89% for duration of disease longer than 6 months. These analgesic effects were associated with long-term improvement in rating-scale items related to QOL. CONCLUSION The results suggest that rTMS is an effective and safe therapy in patients with PHN.

The Long-Term Effective Rate of Different Branches of Idiopathic Trigeminal Neuralgia After Single Radiofrequency Thermocoagulation: A Cohort Study.

AbstractTo evaluate the efficacy of computed tomography (CT) guided single radiofrequency thermocoagualtion (RFT) in 1137 patients with idiopathic trigeminal neuralgia after a follow-up period of 11 years, specially focused on duration of pain relief in different branches of trigeminal nerve, side effect, and complications.Retrospective study of patients with idiopathic trigeminal neuralgia treated with a single CT guided RFT procedure between January 2002 and December 2013.The mean follow-up time was 46.14 ± 30.91 months. Immediate postprocedure pain relief was 98.4%. V2 division obtained the best pain relief rate: 91%, 89%, 80%, 72%, 60%, and 54% at 1, 3, 5, 7, 9, and 11 years, respectively. No statistical difference pairwise comparison was in other groups. The complications included masseter muscle weakness, corneitis, diplopia, ptosis, hearing loss, limited mouth opening, and low pressure headache. Masticatory weakness mostly occurred in patients with V3 branch involvement, while Corneitis and Diplopia all in patients with V1 branch involvement. No mortalities observed during or after RFT.All different branches division of trigeminal neuralgia achieved comparable satisfactory curative effect; V2 obtained the best excellent pain relief, after RFT procedure. Facial numbness is inevitable after RFT, which patients who have pain in all 3 trigeminal divisions and patients who desire no facial numbness should be cautious. Masticatory weakness is mainly related with V3 injured, while Corneitis and Diplopia in patients with V1 injured by RFT.

Percutaneous trigeminal ganglion radiofrequency thermocoagulation alleviates anxiety and depression disorders in patients with classic trigeminal neuralgia: A cohort study.

Abstract Trigeminal neuralgia (TN) is a neurological condition that presents as excruciating facial pain. Depression and anxiety are commonly associated with TN; however, anxiety and depression disorders in patients with TN and the effects of the various therapeutic strategies for TN on these disorders are not well studied. To evaluate depression and anxiety in patients with trigeminal neuralgia (TN), identify factors that predict their occurrence and study the effect of the percutaneous trigeminal ganglion radiofrequency thermocoagulation (PRT) procedure for alleviating pain on depression and anxiety. Patients with classic TN, who received PRT treatment, were consecutively recruited between October 2014 and October 2015. Severity of pain was determined using the visual analogue scale (VAS) score. Beck Depression Inventory-II (BDI) and Beck anxiety Inventory (BAI) were used to evaluate depression and anxiety disorders pre- and post-PRT. Medical, demographic, and psychosocial backgrounds were also assessed as predictive factors. A BDI score of ≥14 represented depression and BAI score of ≥45 represented anxiety. VAS, BDI, and BAI scores were collected at the time of admission and on the day of discharge. Of the 167 patients who participated in the study, 121 (72.5%) had depression and 34 (20.4%) suffered anxiety. Pre-PRT procedure, female sex, age >50 years, ineffective treatment, and high pain intensity (VAS ≥7) predicted the development of depression and anxiety. Post-PRT procedure, all patients who experienced pain relief also reported amelioration of depression and anxiety. A considerable percentage of patients with TN developed depression and anxiety. Patients who were female, older than 50 years, or suffered from failure treatment and severe pain (VAS>7), were at higher risk of depression and anxiety development. Complete alleviation of pain by using surgical PRT could immediately attenuate depressive and anxiety disorders associated with TN.

Clinical study of cerebrospinal fluid neuropeptides in patients with primary trigeminal neuralgia

OBJECTIVES To investigate the expression levels of calcitonin gene-related peptide (CGRP), substance P (SP), vasoactive intestinal peptide (VIP), and β-endorphin in the cerebrospinal fluid (CSF) and peripheral blood of patients with primary trigeminal neuralgia (TN). PATIENTS AND METHODS We included 20 patients with primary TN who underwent percutaneous radiofrequency thermocoagulation and collected four types of samples from all of them: sample A: CSF samples; sample B: peripheral blood samples; sample C: peripheral blood samples collected one day before the operation; sample D: peripheral blood samples withdrawn one day after the operation. Another 20 CSF samples of patients with nervous system disease or gynecological disease were collected as a control (sample E). Samples A and B were obtained at the same time. We also evaluated the expression of CGRP, SP, β-endorphin, and VIP by visual analog scale (VAS) scores one day before and one day after the operation. In addition, heart rate (HR) at baseline and at the time of sample collection, mean arterial pressure (MAP), and all side effects of the procedure were recorded. RESULTS Significance were found concerning about CGRP, SP, β-endorphin, and VIP in TN patients and the controls (P<0.001). The expression of CGRP, SP, and VIP in sample A was higher than that in sample E. However, the β-endorphin level in sample A was lower than that in sample E. There was a positive correlation between sample A and B regarding the expression of CGRP, SP, β-endorphin, and VIP (P<0. 01). There was no relationship between the time of disease onset and the expression of CGRP, SP, β-endorphin, and VIP in sample A and sample B (P>0.05). No difference was detected between the neuropeptides levels in samples B and C (P>0.05). Notably, VAS in sample D was significantly lower than that in sample C (P<0.01). Finally, there was no difference between the intraoperative HR and MAP values in the studied samples. CONCLUSION In primary TN patients, the blood levels of CGRP, SP, β-endorphin, and VIP were associated with those in CSF samples. There was a significant difference between the levels of the four neuropeptides in CSF and control samples. Our results also indicated that the levels of neuropeptides in blood samples can be tested for those in CSF. The disease onset and duration exerted insignificant effects on the production and release of CGRP, SP, β-endorphin, and VIP.

CT-Guided Percutaneous Radiofrequency Thermocoagulation for Recurrent Trigeminal Neuralgia After Microvascular Decompression: A Cohort Study.

AbstractThis article evaluates the long-term outcomes of computed tomography (CT)-guided percutaneous radiofrequency thermocoagulation (PRT) for patients with recurrent trigeminal neuralgia (TN) after microvascular decompression (MVD).This is a retrospective study of 41 patients with intractable TN who after MVD underwent CT-guided PRT procedures between 2002 and 2012.The mean length of follow-up after PRT was 44.4 months. Immediate pain relief was in 37 patients (90.2%); the percentage of patients who remained in “excellent” or “good” pain relief condition after CT-guided PRT procedure was 85% at 1 year, 80% at 2 years, 51% at 5 years, and 41% at 10 years. Six patients received the second PRT and all achieved “excellent” or “good” pain relief. In total, 34 of these patients (82.9%) received multi-PRT procedure and remained satisfied with their pain relief during the follow-up period. Postoperative complications included facial numbness in 36 patients, limited eyes opening in 1 patient, ear paresthesia in 1 patient, no tears in 1 patient, and taste hypesthesia in 1 patient; these symptoms were all improved in the process of follow-up and their life had not severely affected. No mortality was observed during and after CT-guided PRT procedures.CT-guided PRT should be considered as an alternative treatment for patients with recurrent TN after MVD.

Long-term outcomes of percutaneous radiofrequency thermocoagulation for glossopharyngeal neuralgia: A retrospective observational study

AbstractThe aim of this study was to investigate the long-term results of computed tomography (CT)-guided percutaneous radiofrequency thermocoagulation (PRT) for glossopharyngeal neuralgia (GPN).A retrospective review of medical records for patients with GPN who were treated with CT-guided PRT between 2003 and 2014 was performed to investigate baseline characteristics and immediate outcomes during the hospitalization. Long-term pain relief outcomes and complications were obtained via telephone survey. Duration of pain-free was assessed by Kaplan–Meier analysis.Eighty patients with GPN were treated with CT-guided PRT, and 71 patients could be contacted for the follow-up. The mean length of follow-up after PRT was 56.2 ± 43.3 months. Pain relief occurred in 63 patients (78.8%) immediate after the PRT procedure. The percentage of patients who remained in an “excellent” or “good” pain relief condition was 73.2%, 63.0%, 53.2%, and 43.0% at 1, 3, 5, and 10 years. Postprocedure complication included dysesthesias, dysphagia, and diminished gag reflex. No mortality was observed during or after PRT procedures.This study indicates that CT-guided PRT is a safe and effective method for patients with GPN and should be considered as an alternative treatment for these patients.

Efficacy of Coblation Technology in Treating Cervical Discogenic Upper Back Pain

AbstractUpper back pain originating from the cervical disk itself is defined as cervical discogenic upper back pain. Coblation procedures can provide therapeutic effects for neck and radicular pain related to contained cervical disk herniation. However, no studies have reported the performance of coblation procedures, particularly for treating cervical discogenic upper back pain. The purpose of this study was to evaluate the efficacy of coblation procedures in treating cervical discogenic upper back pain.In a prospective, clinical, observational study, 28 consecutive patients with discogenic upper back pain underwent coblation procedures on the cervical disk with a percutaneous anterior approach. Pain visual analogue scale (VAS) scores, patient responses stating significant (≥50%) pain relief, significant (≥50%) reduction in pain medicine intake and Modified MacNab criteria were adopted to evaluate the pain intensity, degree of pain relief, and functional status after 12 months of follow-up.The preoperative pain VAS score was 6.5 ± 1.1 (95% confidence interval [CI] 6.085–6.915), and the pain VAS score significantly decreased to 2.4 ± 1.3 (95% CI 1.929–2.928), 2.5 ± 1.5 (95% CI 1.963–3.109), 2.7 ± 1.4 (95% CI 2.157–3.271), 3.1 ± 1.6 (95% CI 2.457–3.686), and 3.1 ± 1.6 (95% CI 2.471–3.743) at 1 week and 1, 3, 6, and 12 months postoperatively, respectively (P < 0.05). Twenty-two (78.6%), 21 (75.0%), 20 (71.4%), 19 (67.9%), and 18 (64.3%) of the patients expressed significant pain relief at 1 week and 1, 3, 6, and 12 months postoperatively, respectively. 24 (85.7%), 23 (82.1%), 23 (82.1%), and 22 (78.6%) reported significant reduction in pain medication intake at 1, 3, 6, and 12 months postoperatively, respectively. According to the Modified MacNab criteria, the numbers of patients with “excellent” or “good” ratings were 22 (78.6%), 21 (75.0%), 20 (71.4%), and 18 (64.3%) at 1, 3, 6, and 12 months postoperatively, respectively. No serious complications were observed.The findings of this study showed that coblation is an effective, safe, minimally invasive, and less uncomfortable procedure for the treatment of discogenic upper back pain.

Efficacy of Coblation Annuloplasty in Discogenic Low Back Pain: A Prospective Observational Study

AbstractIn degenerative disc, the innervated outer annulus is confirmed to the major origin resulted in discogenic pain. To alleviate the discogenic pain, annuloplasty with electrothermal technology was proved to be effective, which mainly involves the thermal heating of the annulus to denature collagen fibers and denervate posterior annular nerve fibers. However, little is known that efficacy of annuloplasty with coblation technology in treating discogenic pain through directly interrupting nerves in outer annulus.The purpose of this study was to evaluate the clinical outcomes of coblation annuloplasty for the treatment of discogenic low back pain.In a clinical prospective observational study, 17 consecutive patients with discogenic low back pain underwent coblation annuloplasty under local anesthesia. Pain visual analogue scale (VAS) scores, patient responses stating significant (≥50%) pain relief, and modified MacNab criteria were adopted to evaluate the pain intensity, degree of pain relief, and functional status after 6 months of follow-up.The preoperative pain VAS score was 6.5 ± 0.8(95% confidence interval [CI] 6.1–6.9) and the pain VAS score decreased to 2.9 ± 1.6 (95% CI 2.1–3.8), 2.9 ± 1.7 (95% CI 2.1–3.8), 3.2 ± 1.6 (95% CI 2.4–4.1), 3.2 ± 1.7 (95% CI 2.4–4.2) at 1 week and 1, 3 and 6 month postoperatively, respectively. 12 (70.6%), 11 (64.7%), 10 (58.8%) and 10 (58.8%) of patients reported significant pain relief at 1 week and 1, 3 and 6 months postoperatively. At 1, 3, and 6 months postoperatively, the numbers of patients with “excellent” or “good” ratings were 13 (76.5%), 11 (64.7%), and 10 (58.8%) according to the modified MacNab criteria. No serious complications were observed.The finds show that coblation annuloplasty is an effective, safe, and less uncomfortable procedure in managing discogenic low back pain.

Trigeminal somatosensory-evoked potential: A neurophysiological tool to monitor the extent of lesion of ganglion radiofrequency thermocoagulation in idiopathic trigeminal neuralgia: A case-control study.

Abstract To reflect the extent of thermolesion of ganglion by testing the change of trigeminal somatosensory-evoked potential (TSEP) before and after ganglion radiofrequency thermocoagulation surgery (GRT), and evaluate long-term clinic effect by follow-up visiting of 1 year. Patients with idiopathic trigeminal neuralgia (TN) in the second division were enrolled between October 2014 and October 2015. They were treated with computed tomography-guided GRT and a follow-up visiting of 1 year. Bilateral TSEP measurements were performed 1 day before and 2 days after the GRT surgery. The latency and peak-to-peak amplitude of W2 and W3 were recorded. Immediate postprocedure pain relief (grades I–III) was 100% and 92.5% 1 year later. Facial numbness rate of grades III and IV was 70%, 40%, and 12.5%, respectively, at immediate, 2 days, and 1 year after GRT. No sever complications happened. The latency of W2 and W3 of patients who had no pain no numbness after 1 year of GRT was 1.74 ± 0.24 and 3.84 ± 0.66 ms, respectively, of TN side, and 1.71 ± 0.39 and 3.63 ± 0.85 ms of the healthy side before GRT. The amplitude of W2 and W3 was 1.13 ± 0.50 and 1.99 ± 1.09 uv, respectively, of TN side and 1.24 ± 0.40 and 1.89 ± 0.81 uv of the healthy side before GRT. There was no statistical difference of the latency and amplitude between 2 sides of W2 and W3 before surgery (P > 0.05). The latency of W2 and W3 delayed and the amplitude reduced especially in TN side after surgery comparing before (P < 0.001). And, comparisons of the latency and amplitude of W2 and W3 between TN side and the healthy side after surgery showed the latency of W2 and W3 delayed (W2: P = 0.02; W3: P = 0.01) and the amplitude of W2 reduced (P = 0.003), but the amplitude of W3 had no statistical difference (P = 0.22). The mean delayed latency and 95% confident interval of W2 and W3 were 0.22 ± 0.35 (0.1–0.34) ms and 0.35 ± 0.64 (0.14–0.57) ms, respectively. The mean decreased amplitude and 95% confident interval of W2 and W3 were 22 ± 24 (14–30)% and 23 ± 32 (12–34)%, respectively. GRT can make the latency delay and the amplitude decrease of TSEP. And the latency and amplitude of W2 and W3 can be considered reliable and safe reference for monitoring the extent of thermolesion.