Percutaneous Radiofrequency Trigeminal Rhizotomy in a Patient with an Implanted Cardiac Pacemaker

The Utility of Magnetic Resonance Imaging-compatible Pacemakers in Neurosurgical Patients

Artificial implantable pacemakers have long been a challenge to neurosurgeons seeking to perform advanced diagnostic imaging on their patients. Unfortunately, while the use of implantable pacemakers has been a life-saving advance for those with cardiac arrhythmias, they also often prevent these patients from undergoing magnetic resonance imaging (MRI). There have been multiple reported cases of pacemaker failure in the context of MRI use. Recent technological advances, however, have allowed the development of pacemakers that are not affected by the MRI scanner. Similar technology has also been applied to the development of MRI-compatible spinal cord stimulators and other neurostimulation devices. In this paper, we discuss four specific neurosurgical cases where the use of MRI was critical for diagnostic and therapeutic decision-making. Current non-MRI-compatible pacemakers were exchanged for MRI-compatible pacemaker technology with some associated cost and risk. The diagnostic cranial and spinal MRIs subsequently obtained were critical for forging the ensuing neurosurgical care. Based on these cases, we extrapolate the importance of MRI-compatible pacemakers to society at large and advocate for the use of such devices in all patients going forward.

Trigeminal Neuralgia, Glossopharyngeal Neuralgia, and Myofascial Pain Dysfunction Syndrome: An Update

Neuropathic pain is a common phenomenon that affects millions of people worldwide. Maxillofacial structures consist of various tissues that receive frequent stimulation during food digestion. The unique functions (masticatory process and facial expression) of the maxillofacial structure require the exquisite organization of both the peripheral and central nervous systems. Neuralgia is painful paroxysmal disorder of the head-neck region characterized by some commonly shared features such as the unilateral pain, transience and recurrence of attacks, and superficial and shock-like pain at a trigger point. These types of pain can be experienced after nerve injury or as a part of diseases that affect peripheral and central nerve function, or they can be psychological. Since the trigeminal and glossopharyngeal nerves innervate the oral structure, trigeminal and glossopharyngeal neuralgia are the most common syndromes following myofascial pain dysfunction syndrome. Nevertheless, misdiagnoses are common. The aim of this review is to discuss the currently available diagnostic procedures and treatment options for trigeminal neuralgia, glossopharyngeal neuralgia, and myofascial pain dysfunction syndrome.

Cardiac device interrogation for safer care of surgical wound patients

Although most clinicians would agree comprehensive assessment of a wound patient is important, not all know the importance of including cardiac device interrogation as part of the standard preoperative evaluation. Using clinical exemplars, the authors highlight key concepts to raise awareness among wound colleagues of this important patient safety concern.

Radiofrequency and microwave tumor ablation in patients with implanted cardiac devices: is it safe?

PURPOSE

To identify malfunction of implanted cardiac devices during or after thermal ablation of tumors in lung, kidney, liver or bone, using radiofrequency (RF) or microwave (MW) energy.

MATERIALS AND METHODS

After providing written consent, 19 patients (15 men and 4 women; mean age 78 years) with pacemakers or pacemaker/defibrillators underwent 22 CT image-guided percutaneous RF or MW ablation of a variety of tumors. Before and after each procedure, cardiac devices were interrogated and reprogrammed by a trained cardiac electrophysiology fellow. Possible pacer malfunctions included abnormalities on electrocardiographic (EKG) monitoring and alterations in device settings. Our institutional review board approved this Health Insurance Portability and Accountability Act-compliant study. Informed consent for participation in this retrospective study was deemed unnecessary by our review board.

RESULTS

During 20 of 22 sessions, no abnormalities were identified in continuous, EKG tracings or pacemaker functions. However, in two sessions significant changes, occurred in pacemaker parameters: inhibition of pacing during RF application in one, session and resetting of mode by RF energy in another session. These changes did not, result in hemodynamic instability of either patient. MW ablation was not associated with, any malfunction. In all 22 sessions, pacemakers were undamaged and successfully reset to original parameters.

CONCLUSION

RF or MW ablation of tumors in liver, kidney, bone and lung can be performed safely in patients with permanent intra-cardiac devices, but careful planning between radiology and cardiology is essential to avoid adverse outcomes.