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Gupta B, Sabahi M, Santos RC, Srinivash Ramesh Babu Y, Santiago RACB, Dabecco R, Phang-Lyn S, Adada B, Borghei-Razavi H. Intra-operative hypertension as a predictor of surgical outcomes in microvascular decompression surgery for trigeminal neuralgia. Acta Neurochir (Wien) 2024; 166:297. [PMID: 39004670 PMCID: PMC11247045 DOI: 10.1007/s00701-024-06178-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE The trigeminocardiac reflex (TCR) has traditionally been characterized by a sudden decrease in heart rate, asystole, or hypotension during the manipulation of the trigeminal nerve (MTN) or its branches. While this classical TCR is well-documented, there is limited literature on alternative forms of TCR, such as the development of intraoperative hypertension (HTN) or tachycardia, and the underlying pathogenesis. Furthermore, a gap exists in understanding the correlation between intraoperative blood pressure readings and postoperative outcomes, particularly regarding pain relief in patients with trigeminal neuralgia (TN). Our study aims to examine intraoperative blood pressure trends during microvascular decompression (MVD) for TN and assess their impact on postoperative outcomes. METHODS We selected 90 patients who underwent MVD for TN treatment. Blood pressure and heart rate were recorded both preoperatively and during the procedure, specifically during the MTN period, using an arterial line. The Barrow Neurological Institute (BNI) Pain Scale was calculated for all patients both pre- and post-operatively to evaluate pain relief after surgery. RESULTS The mean age of the patients was 61.0 ± 12.35 years, with 64.4% being females. Classical TCR (hypotension) was observed in only 2.2% of patients, whereas 80% of patients developed hypertension (≥ 140/90) during MTN. The mean preoperative systolic blood pressure was 128 ± 22.25, and the mean intraoperative systolic blood pressure during MTN was 153.1 ± 20.2. An analysis of covariance, utilizing either preoperative BNI or duration of symptoms as covariate variables, revealed a statistically significant association between intraoperative HTN and postoperative BNI. A linear regression model demonstrated that intraoperative HTN following MTN significantly predicted a lower postoperative BNI score (p = 0.006). CONCLUSIONS Intraoperative HTN during MTN, an observed yet underexplored phenomenon, demonstrated a correlation with improved postoperative outcomes. Furthermore, it is recommended to conduct additional investigations into potential neurovascular conflicts in patients not manifesting intraoperative HTN following MTN. A comprehensive understanding of TCR, encompassing its various forms, is vital for optimizing surgical management. This study underscores the imperative for further research to unravel the mechanisms linking intraoperative HTN to surgical outcomes in TN patients.
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Affiliation(s)
- Bhavika Gupta
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Mohammadmahdi Sabahi
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Romel Corecha Santos
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA
| | | | | | - Rocco Dabecco
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Simone Phang-Lyn
- Department of Anesthesiology, Cleveland Clinic Florida, Weston, FL, USA
| | - Badih Adada
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Hamid Borghei-Razavi
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA.
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Abboud T, Malinova V, Rohde V, Mielke D. Radiofrequency thermocoagulation under neuromonitoring guidance and general anesthesia for treatment of refractory trigeminal neuralgia. Acta Neurochir (Wien) 2024; 166:56. [PMID: 38302773 PMCID: PMC10834569 DOI: 10.1007/s00701-024-05964-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/06/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Radiofrequency thermocoagulation (RFT) for refractory trigeminal neuralgia is usually performed in awake patients to localize the involved trigeminal branches. It is often a painful experience. Here, we present RFT under neuromonitoring guidance and general anesthesia. METHOD Stimulation of trigeminal branches at the foramen ovale with the tip of the RFT cannula is performed under short general anesthesia. Antidromic sensory-evoked potentials (aSEP) are recorded from the 3 trigeminal branches. The cannula is repositioned until the desired branch can be stimulated and lesioned. CONCLUSION aSEP enable accurate localization of involved trigeminal branches during RFT and allow performing the procedure under general anesthesia.
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Affiliation(s)
- Tammam Abboud
- Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Vesna Malinova
- Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Dorothee Mielke
- Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
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Zhao D, Li J, Ma C, Huang Y, Tao G. Cardiovascular response to Gasserian ganglion ablation on trigeminal neuralgia under local anesthesia: a retrospective single-blind case-control study. BMC Anesthesiol 2022; 22:104. [PMID: 35410169 PMCID: PMC8996585 DOI: 10.1186/s12871-022-01644-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Radiofrequency thermocoagulation of Gasserian ganglion brings with it the difficult problem of how to provide adequate acesodyne therapy for patients in order to make the treatment more comfortable. In our study, we assess the safety and efficacy of lidocaine local anesthesia in the treatment of trigeminal neuralgia. Methods From January, 2017 to December, 2020, 80 patients in our hospital who were suffering from trigeminal neuralgia were treated with radiofrequency thermocoagulation through oval foramen. They were all enrolled in our study and randomly divided into a study group and a placebo group. In the study group an appropriate concentration of lidocaine was given outside and inside of the oval foramen after puncturing in place, while in the placebo group the same dose of normal saline was given in the same way. We then recorded the mean arterial pressure (MAP), heart rate (HR) and visual analogue scale (VAS) at different treatment temperatures. Results The values of MAP and HR in the study group were generally lower than those in the placebo group, and the difference was statistically significant. Additionally, the two groups showed a significant difference in MAP, HR, and VAS at different treatment temperatures. There were significant differences in MAP and VAS between the study group at the baseline as well as each time point thereafter, and the range of MAP and HR in the study group were lower than those in the placebo group. Conclusion Reasonable lidocaine local anesthesia can provide analgesic effects and prevent hypertension and arrhythmia during Gasserian ganglion radiofrequency thermocoagulation for the treatment of trigeminal neuralgia.
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Affiliation(s)
- Dingliang Zhao
- Department of Pain Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, Province Jiangsu, China
| | - Jing Li
- Department of Pain Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, Province Jiangsu, China
| | - Chao Ma
- Department of Pain Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, Province Jiangsu, China
| | - Ying Huang
- Department of Pain Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, Province Jiangsu, China
| | - Gaojian Tao
- Department of Pain Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, Province Jiangsu, China.
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Lee YH, Hong JH, Shin HK. Gasserian ganglion radiofrequency thermoablation in a patient with aneurysm of the anterior communicating artery -A case report. Anesth Pain Med (Seoul) 2022; 16:382-386. [PMID: 35139620 PMCID: PMC8828629 DOI: 10.17085/apm.21019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background Gasserian ganglion radiofrequency thermoablation is a good treatment option for the management of pain in trigeminal neuralgia. We report a case in which the patient of trigeminal neuralgia combined with anterior cerebral artery aneurysm was treated successfully by gasserian ganglion thermoablation without any complication. Case An 85-year-old female presenting with electric shock like sensation in the gum and molar teeth was diagnosed as trigeminal neuralgia. Carbamazepine medication and trigeminal nerve blockade relieved her pain partially, but severe side effects of carbamazepine occurred. Magnetic resonance angiography of the brain showed saccular aneurysm in inferior aspect of the anterior communicating artery. Gasserian ganglion thermoablation under sedation anesthesia using nicardipine was performed carefully without any rupture of the cerebral aneurysm. Conclusions Gasserian ganglion thermoablation could be performed safely in a patient with cerebral aneurysm without any inadvertent event.
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Affiliation(s)
- Yong Ho Lee
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Ji Hee Hong
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Hye Kyung Shin
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
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Fan X, Fu Z, Ma K, Tao W, Huang B, Guo G, Huang D, Liu G, Song W, Song T, Xiao L, Xia L, Liu Y. Chinese expert consensus on minimally invasive interventional treatment of trigeminal neuralgia. Front Mol Neurosci 2022; 15:953765. [PMID: 35966020 PMCID: PMC9368781 DOI: 10.3389/fnmol.2022.953765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/27/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Trigeminal neuralgia is a common condition that is associated with severe pain, which seriously affects the quality of life of patients. When the efficacy of drugs is not satisfactory or adverse drug reactions cannot be tolerated, minimally invasive interventional therapy has become an important treatment because of its simple operation, low risk, high repeatability and low cost. In recent years, minimally invasive interventional treatments, such as radiofrequency thermocoagulation (RF) of the trigeminal nerve and percutaneous microcompression (PMC), have been widely used in the clinic to relieve severe pain in many patients, however, some related problems remain to be addressed. The Pain Association of the Chinese Medical Association organizes and compiles the consensus of Chinese experts to standardize the development of minimally invasive interventional treatment of trigeminal neuralgia to provide a basis for its clinical promotion and application. MATERIALS AND METHODS The Pain Association of the Chinese Medical Association organizes the Chinese experts to compile a consensus. With reference to the evidence-based medicine (OCEBM) system and the actual situation of the profession, the Consensus Development Committee adopts the nominal group method to adjust the recommended level. RESULTS Precise imaging positioning and guidance are the keys to ensuring the efficacy and safety of the procedures. RF and PMC are the most widely performed and effective treatments among minimally invasive interventional treatments for trigeminal neuralgia. CONCLUSIONS The pain degree of trigeminal neuralgia is severe, and a variety of minimally invasive intervention methods can effectively improve symptoms. Radiofrequency and percutaneous microcompression may be the first choice for minimally invasive interventional therapy.
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Affiliation(s)
- Xiaochong Fan
- Department of Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhijian Fu
- Department of Pain Medicine, Shandong Provincial Hospital Affliated to Shandong First Medical University, Jinan, China
| | - Ke Ma
- Department of Pain Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Tao
- Department of Functional Neurosurgery, Shenzhen University General Hospital, Shenzhen, China
| | - Bing Huang
- Department of Pain Medicine, The Affliated Hospital of Jiaxing University, Jiaxing, China
| | - Gang Guo
- Department of Interventional Medicine, Lanzhou University First Hospital, Lanzhou, China
| | - Dong Huang
- Department of Pain Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Guangzhao Liu
- Department of Pain Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wenge Song
- Department of Pain Medicine, Shandong Provincial Hospital Affliated to Shandong First Medical University, Jinan, China
| | - Tao Song
- Department of Pain Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Lizu Xiao
- Department of Pain Medicine, The Union Shenzhen Hospital of Huazhong Science and Technology University, Shenzhen, China
| | - Lingjie Xia
- Department of Pain Medicine, Henan Provincial People’s Hospital, Zhengzhou, China
- *Correspondence: Lingjie Xia,
| | - Yanqing Liu
- Department of Pain Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Yanqing Liu,
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Ma Y, Hsu G, Zhang F. The applicability and efficacy of magnetic resonance-guided high intensity focused ultrasound system in the treatment of primary trigeminal neuralgia. Med Hypotheses 2020; 139:109688. [PMID: 32240878 DOI: 10.1016/j.mehy.2020.109688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/23/2020] [Indexed: 12/27/2022]
Abstract
Primary trigeminal neuralgia is a common clinical refractory neuralgia characterized by an onset of excruciating pain that can severely affect patients' quality of life. Long-term suffering from this pain may lead to depression, anxiety, and suicide. Current treatments, however, are associated with high recurrent rates and severe complications. We hypothesize that both the applicability and efficacy of magnetic resonance-guided high intensity focused ultrasound (MR-HIFU) treatment in primary trigeminal neuralgia can be achieved under the following conditions: a specific target focus and incident channel, a temperature measurement system that does not incur damage to surrounding tissues, and an optimal radiation dose. Successful non-invasive treatment of primary trigeminal neuralgia by MR-HIFU systems could represent a breakthrough of this technology applied to the oral and maxillofacial region.
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Affiliation(s)
- Yaping Ma
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Stomatological Hospital of Chongqing Medical University, Chongqing 401147, China; Department of Oral and Maxillofacial Surgery, Stomatological Hospital of Chongqing Medical University, Chongqing 401147, China
| | - Grace Hsu
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Fugui Zhang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital of Chongqing Medical University, Chongqing 401147, China; Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
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Effects of Supraorbital Foramen Variations on the Treatment Efficacy of Radiofrequency Therapy for V1 Trigeminal Neuralgia: A Retrospective Study. Pain Res Manag 2020; 2020:8142489. [PMID: 32184911 PMCID: PMC7061117 DOI: 10.1155/2020/8142489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/01/2020] [Indexed: 01/03/2023]
Abstract
Background Primary V1 trigeminal neuralgia is a common refractory neuralgia in clinical practice, lacking effective treatments. Radiofrequency therapy has certain treatment efficacy, but its long-term efficacy remained poor and the disease might relapse. Objective To compare the effects of different types of supraorbital foramen variations on the treatment efficacy of radiofrequency therapy for V1 trigeminal neuralgia. Methods Data of 54 patients with V1 trigeminal neuralgia who underwent treatment in the First Hospital of Jiaxing, Zhejiang, were retrospectively analyzed. All these patients received CT-guided radiofrequency thermocoagulation of supraorbital nerve. According to the CT images, the supraorbital foramen of the patients was categorized as holes (hole group) or notches (notch group). The patient characteristics, including Numerical Rating Scale (NRS) score and effective treatment rates before and 1 d, 0.5 y, 1 y, and 2 y after operation, and numbness degree at day 1 and 2 y after the operation were compared. The short- and long-term complications during postoperative follow-up period were also recorded. Results Among the 54 patients, 25 patients were grouped into the hole group and 29 into the notch group. The NRS scores before and at 1 d, 0.5 y, 1 y, and 2 y after operation showed no significant differences between the two groups. However, the NRS scores at the remaining time points after operation were significantly decreased when compared with scores before operation (P < 0.05). The numbness and numbness degree after operation showed no significant differences between the two groups. The numbness degree at 2 y after operation was significantly lower than 1 d after operation (P < 0.05). The numbness and numbness degree after operation showed no significant differences between the two groups. The numbness degree at 2 y after operation was significantly lower than 1 d after operation (P < 0.05). The numbness and numbness degree after operation showed no significant differences between the two groups. The numbness degree at 2 y after operation was significantly lower than 1 d after operation ( Conclusion The short- and long-term effective rates of radiofrequency therapy during V1 trigeminal neuralgia treatment are relatively high in patients with different types of supraorbital foramen variations. However, the effective rate is even higher in patients with hole-type supraorbital foramen. No other severe complications, except numbness, were found, and the acceptability rate remained high in patients.
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Nasi-Kordhishti I, Tatagiba MS, Ebner FH. Microvascular decompression for treating classical trigeminal neuralgia: can we offer the gold standard therapy to older patients? Eur Geriatr Med 2019; 10:939-945. [PMID: 34652772 DOI: 10.1007/s41999-019-00243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/11/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Microvascular decompression is the most successful procedure for treating classic trigeminal neuralgia. However, due to the risks of surgery and anesthesia, the procedure is performed less frequently in older patients. The aim of the study is to investigate the intraoperative and perioperative morbidity in older patients who underwent this surgical treatment. METHODS Patients who underwent microvascular decompression in our department between 2004 and 2016 were divided into two age groups (A: < 69 years old, n = 114; B: ≥ 70 years old, n = 47). Retrospectively, the pre-, intra- and postoperative data were analyzed. RESULTS Older patients showed a statistically significant prolonged duration of symptoms until surgery (mean 127 months vs. 70 months; p < 0.001). They also showed a significantly increased necessity for duroplasty (p = 0.015), but with no increased incidence of postoperative cerebrospinal fluid leakage or rhinoliquorrhea. A comparable postoperative course was found in both groups. Over 90% in both groups had a significantly postoperative improvement. There were no cardiopulmonary complications or infections in either group. In the 3-month follow-up, there was a comparable success of pain reduction and no increased incidence of sensory disturbances. CONCLUSIONS Based on the high chances of success and low morbidity, microvascular decompression should also be offered to older patients with anesthesiologic agreement.
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Affiliation(s)
- Isabella Nasi-Kordhishti
- Department of Neurosurgery, Eberhard Karls University, Tuebingen, Germany. .,Department of Neurosurgery, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| | | | - Florian Heinrich Ebner
- Department of Neurosurgery, Eberhard Karls University, Tuebingen, Germany.,Department of Neurosurgery, Alfried Krupp Hospital, Essen, Germany
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Huang B, Yao M, Liu Q, Chen Y, Ni H, Li Z, Xie K, Fei Y, Li L. Personalized needle modification for CT-guided percutaneous infrazygomatic radiofrequency ablation of the maxillary nerve through the foramen rotundum in order to treat V2 trigeminal neuralgia. J Pain Res 2019; 12:2321-2329. [PMID: 31440076 PMCID: PMC6666371 DOI: 10.2147/jpr.s207297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/08/2019] [Indexed: 11/24/2022] Open
Abstract
Background: The computed tomography (CT)-guided radiofrequency ablation (RFA) of the maxillary nerve (V2) via foramen rotundum (FR) approach has been reported to offer the highest rates of pain relief in V2 trigeminal neuralgia (TN). However, the access to FR may be obstructed by the greater wing of the sphenoid bone. Objectives: We report on an optimized CT-guided percutaneous infrazygomatic of maxillary nerve through the foramen rotundum (FR) to treat V2 trigeminal neuralgia (TN) using personalized RFA needles based on patient’s individual CT-image parameters. Patients and methods: 176 patients with isolated V2 TN were included. If the entry of the percutaneous needle into the FR canal was blocked by the greater wing of the sphenoid bone, straight RFA needles was bent at the tip with an angle α (the angle between the straight line from the external opening of FR to the skin entry point and the long axis of the FR canal). The maxillary nerve RFA was performed after confirmation with electrophysiological tests. Pain relief in the V2 territory and TN recurrence rate were followed for up to 60 months. Results: Fifty-two patients (29.55%) required needle bending. The maxillary nerve thermal RFA resulted in analgesia in the V2 territory without affecting the V1 or V3 zone. TN recurrence rate at 6, 12, 24, 36, 48 and 60 months was 2.55%, 7.64%, 17.20%, 24.41%, 30.28% and 33.77%, respectively. Conclusion: The personalized needle modification technique for maxillary nerve RFA through FR is safe and effective to treat V2 TN.
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Affiliation(s)
- Bing Huang
- Department of Anesthesiology and Pain Medical Center, First Affiliated Hospital of Jiaxing University, Jiaxing 314001, People's Republic of China
| | - Ming Yao
- Department of Anesthesiology and Pain Medical Center, First Affiliated Hospital of Jiaxing University, Jiaxing 314001, People's Republic of China
| | - Qianying Liu
- Department of Anesthesiology and Pain Medical Center, First Affiliated Hospital of Jiaxing University, Jiaxing 314001, People's Republic of China
| | - Yajing Chen
- Department of Anesthesiology and Pain Medical Center, First Affiliated Hospital of Jiaxing University, Jiaxing 314001, People's Republic of China
| | - Huadong Ni
- Department of Anesthesiology and Pain Medical Center, First Affiliated Hospital of Jiaxing University, Jiaxing 314001, People's Republic of China
| | - Zhang Li
- Department of Anesthesiology and Pain Medical Center, First Affiliated Hospital of Jiaxing University, Jiaxing 314001, People's Republic of China
| | - Keyue Xie
- Department of Anesthesiology and Pain Medical Center, First Affiliated Hospital of Jiaxing University, Jiaxing 314001, People's Republic of China
| | - Yong Fei
- Department of Anesthesiology and Pain Medical Center, First Affiliated Hospital of Jiaxing University, Jiaxing 314001, People's Republic of China
| | - Langping Li
- Department of Anesthesiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, People's Republic of China
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Borghei-Razavi H, Das P, Maurtua M, Recinos PF. Unusual Appearance of Trigemino-Cardiac Reflex During Cerebellopontine Angle Surgery. World Neurosurg 2018; 112:298-299. [PMID: 29580017 DOI: 10.1016/j.wneu.2017.10.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 10/17/2022]
Affiliation(s)
- Hamid Borghei-Razavi
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paramita Das
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marco Maurtua
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pablo F Recinos
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA.
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Guo J, Dong X, Zhao X. Treatment of trigeminal neuralgia by radiofrequency of the Gasserian ganglion. Rev Neurosci 2018; 27:739-743. [PMID: 27383870 DOI: 10.1515/revneuro-2015-0065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/14/2016] [Indexed: 11/15/2022]
Abstract
Trigeminal neuralgia (TN) is a neuropathic pain disorder that affects the trigeminal nerve distribution area. Pharmacological therapy has remained the first-line treatment for TN. If pharmacological intervention is not effective, surgical treatments including radiosurgery (mainly gamma knife therapy), radiofrequency (RF) of the Gasserian ganglion, and microvascular decompression have been utilized. RF is one of the most common procedures used to treat TN. Two RF approaches are commonly utilized: conventional radiofrequency (CRF) and pulsed radiofrequency (PRF). Both methods have been used to successfully treat TN; however, each procedure has distinct advantages and disadvantages. This article summarizes the current relevant literature to compare the treatment of TN with CRF vs. PRF. We discuss the treatment indications, operative methods, and complications of each treatment strategy. Most of the patients treated with CRF had a satisfactory outcome, whereas most PRF patients still had significant pain after the procedure. The application of a higher voltage can improve the curative effect of PRF, and its complications are less than CRF. Both CRF and PRF can be used to treat TN, and the former was more effective. Although the complications of CRF are more than those of PRF, most of them were short-lived and lacked sequelae. The pain relief rate in PRF-treated patients was significantly lower compared to CRF-treated patients. Furthermore, recurring pain was more commonly observed in PRF-treated patients. Therefore, CRF may be the preferred treatment option for TN, whereas treatment with PRF requires further study.
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Trigeminocardiac reflex during endoscopic juvenile nasopharyngeal angiofibroma surgery: an appraisal. Eur Arch Otorhinolaryngol 2017; 274:2779-2784. [PMID: 28324181 DOI: 10.1007/s00405-017-4521-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 02/23/2017] [Indexed: 10/19/2022]
Abstract
Juvenile nasopharyngeal angiofibroma is a locally aggressive benign tumour which has propensity to erode the skull base. The tumour spreads along the pathways of least resistance and is in close proximity to the extracranial part of trigeminal nerve. Advancements in expanded approaches for endoscopic excision of tumours in infratemporal fossa and pterygopalatine fossa increase the vulnerability for the trigeminocardiac reflex. The manipulation of nerve and its branches during tumour dissection can lead to sensory stimulation and thus inciting the reflex. The aim of our study is to report the occurrence of trigeminocardiac reflex in endoscopic excision of juvenile nasopharyngeal angiofibroma. To describe the occurence of trigeminocardiac reflex during endoscopic endonasal excision of juvenile nasopharyngeal angiofibroma. We studied the occurrence of TCR in 15 patients (out of 242 primary cases and 52 revision cases) operated for endoscopic endonasal excision of JNA. The drop in mean arterial blood pressure and heart rate were observed and measured. To the best of our knowledge of English literature, this is the first case series reporting TCR as complication in endoscopic excision of JNA. occurence of this reflex has been mentioned in various occular, maxillofacial surgeries but its occurence during endoscopic excision of JNA has never been reported before. Manifestation of trigeminocardiac reflex during surgery can alter the course of the surgery and is a potential threat to life. It is essential for the anesthetist and surgeons to be familiar with the presentations, preventive measures and management protocols.
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Sandu N, Chowdhury T, Meuwly C, Schaller B. Trigeminocardiac reflex in cerebrovascular surgery: a review and an attempt of a predictive analysis. Expert Rev Cardiovasc Ther 2017; 15:203-209. [DOI: 10.1080/14779072.2017.1286983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nora Sandu
- Department of Research, University of Southampton, Southampton, UK
| | - Tumul Chowdhury
- Department of Anesthesiology and Perioperative Medicine, University of Manitoba (UOM)/Winnipeg Regional Health Authority (WRHA), Winnipeg, Manitoba, Canada
| | | | - Bernhard Schaller
- Department of Research, University of Southampton, Southampton, UK
- Department of Pathology, University of Buenos Aires, Buenos Aires, Argentina
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Meuwly C, Golanov E, Chowdhury T, Erne P, Schaller B. Trigeminal cardiac reflex: new thinking model about the definition based on a literature review. Medicine (Baltimore) 2015; 94:e484. [PMID: 25654391 PMCID: PMC4602726 DOI: 10.1097/md.0000000000000484] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Trigeminocardiac reflex (TCR) is a brainstem reflex that manifests as sudden onset of hemodynamic perturbation in blood pressure (MABP) and heart rate (HR), as apnea and as gastric hypermotility during stimulation of any branches of the trigeminal nerve. The molecular and clinical knowledge about the TCR is in a constant growth since 1999, what implies a current need of a review about its definition in this changing context. Relevant literature was identified through searching in PubMed (MEDLINE) and Google scholar database for the terms TCR, oculocardiac reflex, diving reflex, vasovagale response. The definition of the TCR varies in clinical as well as in research studies. The main difference applies the required change of MABP and sometimes also HR, which most varies between 10% and 20%. Due to this definition problem, we defined, related to actual literature, 2 major (plausibility, reversibility) and 2 minor criteria (repetition, prevention) for a more proper identification of the TCR in a clinical or research setting. Latest research implies that there is a need for a more extended classification with 2 additional subgroups, considering also the diving reflex and the brainstem reflex. In this review, we highlighted criteria for proper definition and classification of the TCR in the light of increased knowledge and present a thinking model to overcome this complexity. Further we separately discussed the role of HR and MABP and their variation in this context. As another subtopic we gave attention to is the chronic TCR; a variant that is rarely seen in clinical medicine.
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Affiliation(s)
- C Meuwly
- From the University of Basel, Switzerland (CM); The Houston Methodist Research Institute, Houston, Texas, USA (EG); Department of Anesthesia and Perioperative Medicine. University of Manitoba, Winnipeg, Canada (TC); Cardiology, St Anna Clinic, Luzern, Switzerland and University of Basel, Switzerland (PE); Department of Research, University of Southampton, United Kingdom (BS); and Academic Editor, Medicine (BS)
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Comparative Study of Trigeminocardiac Reflex After Trigeminal Ganglion Compression During Total Intravenous Anesthesia. J Neurosurg Anesthesiol 2015; 27:16-20. [DOI: 10.1097/ana.0000000000000076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Chowdhury T, Sandu N, Meuwly C, Cappellani RB, Schaller B. Trigeminocardiac reflex: differential behavior and risk factors in the course of the trigeminal nerve. FUTURE NEUROLOGY 2014. [DOI: 10.2217/fnl.13.62] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT; The trigeminocardiac reflex (TCR) is a brainstem reflex describing the acute hemodynamic perturbations in neurosurgical patients. The roles of different anatomic locations of this reflex arc on end responses have been found to be variable. In this article, we have highlighted the role and importance of different TCR pathway (peripheral vs central) mechanisms, their manifestations and the various risk factors associated with these. In addition, new insights into various other non-neurosurgical conditions, in special relation to neurointerventional procedures, are also presented in this article. This study is a narrative review based on a PubMed/Google search (from 1 January 1970 to 31 March 2013) on this topic. The common manifestations, such as hypotension and bradycardia, are vagal-dominated responses; however, unusual manifestations, such as hypertension and tachycardia, signify the involvement of the sympathetic nervous system. In addition, there is a complex interaction of the various sensory receptors at the Gasserian ganglion, and this is responsible for the different presentations. There are many surgical as well as nonsurgical risk factors associated with TCR. Interestingly, TCR may affect functional outcome and has been found to be involved in some normal physiological mechanisms, including bruxism. TCR is a complex neurophysiological reflex and there are variable presentations depending upon the peripheral or central stimulation surrounding the Gasserian ganglion. We suggest, for the first time, that if the TCR is initiated at the Gasserian ganglion, it reacts in a different manner from the better-known central or peripheral TCR.
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Affiliation(s)
- Tumul Chowdhury
- Department of Anesthesia & Perioperative Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Nora Sandu
- Research University of Southampton, South Academic Block, Tremona Road, Southampton, SO16 6YD, UK
| | - Cyrill Meuwly
- University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Ronald B Cappellani
- Department of Anesthesia & Perioperative Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Bernhard Schaller
- Research University of Southampton, South Academic Block, Tremona Road, Southampton, SO16 6YD, UK
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Bordoni B, Zanier E. Anatomic connections of the diaphragm: influence of respiration on the body system. J Multidiscip Healthc 2013; 6:281-91. [PMID: 23940419 PMCID: PMC3731110 DOI: 10.2147/jmdh.s45443] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The article explains the scientific reasons for the diaphragm muscle being an important crossroads for information involving the entire body. The diaphragm muscle extends from the trigeminal system to the pelvic floor, passing from the thoracic diaphragm to the floor of the mouth. Like many structures in the human body, the diaphragm muscle has more than one function, and has links throughout the body, and provides the network necessary for breathing. To assess and treat this muscle effectively, it is necessary to be aware of its anatomic, fascial, and neurologic complexity in the control of breathing. The patient is never a symptom localized, but a system that adapts to a corporeal dysfunction.
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Affiliation(s)
- Bruno Bordoni
- Rehabilitation Cardiology Institute of Hospitalization and Care with Scientific Address, S Maria Nascente Don Carlo Gnocchi Foundation
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Chen CY, Luo CF, Hsu YC, Chen JF, Day YJ. Comparison of the effects of atropine and labetalol on trigeminocardiac reflex-induced hemodynamic alterations during percutaneous microballoon compression of the trigeminal ganglion. ACTA ACUST UNITED AC 2012; 50:153-8. [DOI: 10.1016/j.aat.2012.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 08/06/2012] [Accepted: 08/09/2012] [Indexed: 10/27/2022]
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Cardiovascular Responses During Percutaneous Radiofrequency Thermocoagulation Therapy in Primary Trigeminal Neuralgia: An Explanation of the Trigeminocardiac Reflex? J Neurosurg Anesthesiol 2008; 20:270. [DOI: 10.1097/ana.0b013e3181817b50] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Toda K. Operative treatment of trigeminal neuralgia: review of current techniques. ACTA ACUST UNITED AC 2008; 106:788-805, 805.e1-6. [PMID: 18657454 DOI: 10.1016/j.tripleo.2008.05.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 04/15/2008] [Accepted: 05/14/2008] [Indexed: 10/21/2022]
Abstract
Surgical approaches to pain management are performed when medication cannot control pain or patients cannot tolerate the adverse effects of the medication. Microvascular decompression (MVD) is generally performed when the patient is healthy and relatively young. Partial sensory rhizotomy is performed in addition to, or instead of MVD, in patients in whom significant compression of the trigeminal sensory root does not exist or in whom MVD is technically not feasible. Three percutaneous ablative procedures and gamma knife radiosurgery (GKS) are also performed when MVD cannot be performed. The result of MVD is superior to that of the 3 ablative procedures. GKS is inferior to the 3 ablative procedures in terms of initial pain relief and recurrence, but superior in terms of complications. Peripheral procedures are usually performed in patients not suitable for or not wishing to have other procedures. However, no strict rules exist and each patient should be evaluated individually.
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Affiliation(s)
- Katsuhiro Toda
- Department of Rehabilitation, Hatsukaichi Memorial Hospital, Hatsukaichi, Hiroshima, Japan.
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