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Ma Y, Xu S, Liu X, Xia Z, Zhao W, Huang B. CT-Guided Thermocoagulation of the Pterygopalatine Ganglion for Refractory Trigeminal Autonomic Cephalalgia. Pain Ther 2022; 11:1071-1077. [PMID: 35749031 PMCID: PMC9314506 DOI: 10.1007/s40122-022-00406-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/14/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Trigeminal autonomic cephalalgia (TAC) is a type of one-sided cerebral painful headache, with attacks regularly accompanied by autonomic responses, such as tearing, runny nose, panic, nausea and vomiting on the affected side. Currently, the most common treatment strategies are drugs, nerve grafts and surgery. Clinical understanding of TACs is limited. Here, we report the case of thermocoagulation treatment of the pterygopalatine ganglion in an uncommon TAC under local anesthesia. CASE PRESENTATION A rare case of TAC was treated with computed tomography (CT)-guided thermocoagulation within the pterygopalatine ganglion. Pain and autonomic signs were relieved immediately after surgery, with the patent retaining only slight numbness on the left side of the face. This numbness completely resolved at 6 months of follow-up and there was no recurrence. DISCUSSION Trigeminal autonomic cephalalgia seriously affects the patient's quality of life, but clinical understanding is limited. In the case reported here, we performed CT-guided thermocoagulation of the pterygopalatine ganglion at 90 °C for 180 s for treatment of a trigeminal autonomic headache. To our knowledge, this is the first report of using thermocoagulation at 90 °C to treat the pterygopalatine ganglion. We found that this strategy results in fewer side effects and is a more cost-effective treatment for such patients than other options. CONCLUSION Computed tomography-guided thermocoagulation of the pterygopalatine ganglion at 90 °C for 180 s for treatment of trigeminal autonomic headache is a safe and economical treatment option.
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Affiliation(s)
- Ying Ma
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, No. 1882 Zhong Huan South Road, Jiaxing, 314000 Zhejiang China
| | - Shuangshuang Xu
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, No. 1882 Zhong Huan South Road, Jiaxing, 314000 Zhejiang China
| | - Xiaolan Liu
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, No. 1882 Zhong Huan South Road, Jiaxing, 314000 Zhejiang China
| | - Zhangtian Xia
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, No. 1882 Zhong Huan South Road, Jiaxing, 314000 Zhejiang China
| | - Wei Zhao
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, No. 1882 Zhong Huan South Road, Jiaxing, 314000 Zhejiang China
| | - Bing Huang
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, No. 1882 Zhong Huan South Road, Jiaxing, 314000 Zhejiang China
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Soler M, Masch R, Saidu R, Cremer M. Thermal Ablation Treatment for Cervical Precancer (Cervical Intraepithelial Neoplasia Grade 2 or Higher [CIN2+]). Methods Mol Biol 2022; 2394:867-882. [PMID: 35094363 DOI: 10.1007/978-1-0716-1811-0_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cervical cancer is a leading cause of mortality for women in low- and middle-income countries (LMICs). Invasive disease can be prevented through the treatment of high-grade cervical precancer lesions. Types of treatment for cervical precancer include excisional procedures that surgically remove the affected tissue and ablation treatments which utilize extreme temperatures to destroy precancerous cells. Excision is the first-line treatment in higher income countries, but requires specialized training and equipment that make it unsuitable for low-income settings. The most common treatment globally is cryotherapy, which utilizes cryogenic gas to freeze the area. However, the need for gas presents significant procurement and logistical challenges. The World Health Organization (WHO) has recently endorsed the use of thermal ablation, a method that utilizes heat to destroy precancerous tissue. This review describes three existing thermal ablation devices and protocols for their use, including step-by-step instruction guides to perform a successful treatment with each device and observations specific to each machine.
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Affiliation(s)
- Montserrat Soler
- Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
- Basic Health International, Pittsburgh, PA, USA.
| | | | - Rakiya Saidu
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
| | - Miriam Cremer
- Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
- Basic Health International, Pittsburgh, PA, USA
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Noorani I, Lodge A, Durnford A, Vajramani G, Sparrow O. Comparison of first-time microvascular decompression with percutaneous surgery for trigeminal neuralgia: long-term outcomes and prognostic factors. Acta Neurochir (Wien) 2021; 163:1623-34. [PMID: 33751217 DOI: 10.1007/s00701-021-04793-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/23/2021] [Indexed: 11/04/2022]
Abstract
Objective Common surgical treatments for trigeminal neuralgia (TN) include microvascular decompression (MVD) and percutaneous procedures (glycerol rhizolysis; thermocoagulation; and balloon compression). Although the efficacy of each procedure has been documented, direct comparisons of their relative efficacies for TN are lacking. We aimed to directly compare long-term outcomes after first-time MVD with percutaneous surgery in primary (idiopathic and classical) TN and identify predictors of outcome. Methods We conducted a retrospective analysis of prospectively collected data on 185 patients undergoing MVD and 129 undergoing percutaneous surgery. Procedures were performed by one of two neurosurgeons in a single centre; an independent observer collected long-term follow-up data by interviews, using the same outcome measures for all procedures. Results MVD patients were younger than those undergoing percutaneous surgery (P <.001). MVD provided superior initial pain relief (P <.001): 87.0% had Barrow Neurological Institute class I or II pain scores after MVD compared with 67.2% after percutaneous surgery. The complication rate for percutaneous procedures was 35.7% and for MVDs was 24.9% (P =.04), including minor and transient complications. Kaplan-Meier analysis demonstrated that MVD provided longer pain relief than percutaneous procedures (P <.001); 25% of patients had recurrence at 96 months following MVD compared with 12 months after percutaneous surgery. Subgroup analysis showed that balloon compression provided more durable relief amongst percutaneous procedures. Multivariate analysis revealed that post-operative numbness and age were prognostic factors for percutaneous procedures (P =.03 and .01, respectively). Conclusions MVD provides better initial pain relief and longer durability of relief than percutaneous surgery, although carrying a small risk of major complications. Amongst percutaneous procedures, balloon compression gave the most durable relief from pain. Older age and post-operative numbness were predictors of good outcome from percutaneous surgery. These results can help clinicians to counsel patients with primary TN on neurosurgical treatment selection for pain relief. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-021-04793-4.
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Lee F, Bula A, Chapola J, Mapanje C, Phiri B, Kamtuwange N, Tsidya M, Tang J, Chinula L. Women's experiences in a community-based screen-and-treat cervical cancer prevention program in rural Malawi: a qualitative study. BMC Cancer 2021; 21:428. [PMID: 33882885 PMCID: PMC8061221 DOI: 10.1186/s12885-021-08109-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malawi has the world's highest cervical cancer incidence and mortality due to high rate of HIV coupled with inadequate screening and treatment services. The country's cervical cancer control program uses visual inspection with acetic acid (VIA) and cryotherapy, but screening is largely limited by poor access to facilities, high cost of cryotherapy gas, and high loss-to-follow-up. To overcome these limitations, we implemented a community-based screen-and-treat pilot program with VIA and thermocoagulation. Through a qualitative study, we explore the experiences of women who underwent this community-based pilot screening program. METHODS We implemented our pilot program in rural Malawi and conducted an exploratory qualitative sub-study. We conducted in-depth interviews with women who were treated with thermocoagulation during the program. We used semi-structured interviews to explore screen-and-treat experience, acceptability of the program and attitudes towards self-sampling for HPV testing as an alternative screening method. Content analysis was conducted using NVIVO v12. RESULTS Between July - August 2017, 408 participants eligible for screening underwent VIA screening. Thirty participants had VIA positive results, of whom 28 underwent same day thermocoagulation. We interviewed 17 of the 28 women who received thermocoagulation. Thematic saturation was reached at 17 interviews. All participants reported an overall positive experience with the community-based screen-and-treat program. Common themes were appreciation for bringing screening directly to their villages, surprise at the lack of discomfort, and the benefits of access to same day treatment immediately following abnormal screening. Negative experiences were rare and included discomfort during speculum exam, long duration of screening and challenges with complying with postprocedural abstinence. Most participants felt that utilizing self-collected HPV testing could be acceptable for screening in their community. CONCLUSIONS Our exploratory qualitative sub-study demonstrated that the community-based screen-and-treat with VIA and thermocoagulation was widely accepted. Participants valued the accessible, timely, and painless thermocoagulation treatment and reported minimal side effects. Future considerations for reaching rural women can include community-based follow-up, cervical cancer education for male partners and self-sampling for HPV testing.
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Affiliation(s)
- Fan Lee
- University of North Carolina (UNC) Department of Obstetrics and Gynecology, Chapel Hill, USA.
| | | | | | | | | | | | | | - Jennifer Tang
- University of North Carolina (UNC) Department of Obstetrics and Gynecology, Chapel Hill, USA
- UNC-Project Malawi, Lilongwe, Malawi
| | - Lameck Chinula
- University of North Carolina (UNC) Department of Obstetrics and Gynecology, Chapel Hill, USA
- UNC-Project Malawi, Lilongwe, Malawi
- Kamuzu Central Hospital, Lilongwe, Malawi
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Likar R, Auer J, Chavanne A, Ilias W, Kern M, Krepler P, Kress HG, Lischnig U, Maurer G, Sommer O, Spendel MC, Thurnher S, Wohak K, Wolf A, Wölkhart M. [Interdisciplinary position paper: the value of radiofrequency denervation in the treatment of chronic pain]. Schmerz 2021; 35:124-9. [PMID: 33447917 DOI: 10.1007/s00482-020-00526-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
Radiofrequency denervation has been established for many years as an important minimally invasive procedure for the treatment of chronic pain conditions. Positive experiences of many users for various indications are contrasted by a nonuniform evidence. With meticulous patient selection and correct assessment of the indications a longer term reduction of pain, a reduced need for analgesics and an improvement in the quality of life can be achieved. The aim of this interdisciplinary position paper is to present the value of radiofrequency denervation in the treatment of chronic pain. The summarized recommendations of the expert group are based on the available evidence and on the clinical experiences of Austrian centers that frequently implement the procedure. The position paper contains recommendations on patient selection and proven indications. We discribe safety aspects, complications, side effects and contraindications.
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Chene G, Piana F, Cerruto E, Mathe M, Lamblin G, Nohuz E. [How I do… easily endometrial ablation under paracervical and fundal block with immersive virtual reality?]. Gynecol Obstet Fertil Senol 2020; 48:703-706. [PMID: 32112860 DOI: 10.1016/j.gofs.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Indexed: 06/10/2023]
Affiliation(s)
- G Chene
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant (HFME), 59, boulevard Pinel, 69000 Lyon, France; EMR 3738, université Claude-Bernard Lyon 1, 69000 Lyon, France.
| | - F Piana
- Département d'anesthésie et réanimation, hospices civils de Lyon, hôpital Femme-Mère-Enfant (HFME), 59, boulevard Pinel, 69000 Lyon, France
| | - E Cerruto
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant (HFME), 59, boulevard Pinel, 69000 Lyon, France
| | - M Mathe
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant (HFME), 59, boulevard Pinel, 69000 Lyon, France
| | - G Lamblin
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant (HFME), 59, boulevard Pinel, 69000 Lyon, France
| | - E Nohuz
- Département de gynécologie, hospices civils de Lyon, hôpital Femme-Mère-Enfant (HFME), 59, boulevard Pinel, 69000 Lyon, France
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Méreaux JL, Gilard V, Le Goff F, Chastan N, Magne N, Gerardin E, Maltête D, Lebas A, Derrey S. Practice of stereoelectroencephalography (sEEG) in drug-resistant epilepsy: Retrospective series with surgery and thermocoagulation outcomes. Neurochirurgie 2020; 66:139-43. [PMID: 32278000 DOI: 10.1016/j.neuchi.2019.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/13/2019] [Accepted: 12/01/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to determine the success rate of sEEG in locating the epileptogenic zone (EZ) in patients with pharmaco-resistant epilepsy. Secondary objectives were to analyze sEEG-related morbidity and outcomes for post-sEEG thermocoagulation and cortical resection. METHODS Data were collected on 49 sEEGs from 46 consecutive patients between 2010 and 2018. Following sEEG, either resective or palliative surgery with vagus nerve stimulation was performed. In 8 patients, EZ thermocoagulation was performed before EEG leads were withdrawn. Outcomes were collected based on the Engel and ILAE outcome scales. RESULTS sEEG was contributive in 45 of 49 recordings, with a success rate of 92% in locating the EZ. Minor complications, such as transient neurologic deficit and electrode implantation failures, occurred in 6%. One major complication occurred, with death due to atypical late hematoma. Thermocoagulation was performed in 8 patients and stopped or significantly reduced seizure frequency in 7 (88%). Outcome of surgical resection (n=33) was good, with 20 (61%) seizure-free patients and 32 (97%) with definite improvement. CONCLUSIONS Our findings suggest that sEEG is an effective technique for EZ location in patients with drug-resistant epilepsy. sEEG was contributive in up to 92% of patients, allowing thermocoagulation and/or surgical resection that resulted in seizure-freedom in two-thirds and seizure-reduction in one-third of cases. This study highlights the need for strict selection of implantation candidates, with strong initial hypothesis as to EZ location.
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Bedell SL, Goldstein LS, Goldstein AR, Goldstein AT. Cervical Cancer Screening: Past, Present, and Future. Sex Med Rev 2020; 8:28-37. [PMID: 31791846 DOI: 10.1016/j.sxmr.2019.09.005] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/06/2019] [Accepted: 09/22/2019] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Cervical cancer is the leading cause of cancer deaths in women in the developing world. New technologies have been developed to allow for more rapid, cost-effective, and sensitive cervical cancer screening and treatment. AIM The aim of this study was to describe methods for detection and treatment of human papillomavirus (HPV), cervical dysplasia (CD), and cervical cancer. New technologies and updated screening strategies will be emphasized. METHODS A literature search was conducted using PubMed to identify publications relevant to the subject. MAIN OUTCOME MEASURE Sensitivity and cost-effectiveness of new cervical cancer screening methods were the main outcome measures. RESULTS HPV and cervical cancer have a significant global impact. Research and innovations related to detection and treatment are key in reducing their burden worldwide. CONCLUSION Screening a woman for HPV and CD can dramatically decrease her risk of dying from cervical cancer. New, rapid, low-cost, HPV testing can allow for high-volume screening for the approximately 1.5 billion women who have never been screened. HPV screening can then be combined with high resolution digital colposcopy to detect CD. In the near future, these colposcopic images will be interpreted by artificial intelligence software. Detected lesions can then be treated easily and effectively with thermocoagulation. This see-and-treat model is a sensitive, efficient, and low-cost vision for the future. Bedell SL, Goldstein LS, Goldstein AR, et al. Cervical Cancer Screening: Past, Present, and Future. Sex Med Rev 2020;8:28-37.
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Feigl GC, Mattersberger C, Rosmarin W, Likar R, Avila González C. [Lumbar CT-guided radiofrequency ablation of the medial branch of the dorsal ramus of the spinal nerve : Anatomic study and description of a new technique]. Schmerz 2019; 32:99-104. [PMID: 29564634 DOI: 10.1007/s00482-018-0283-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The success of radiofrequency ablation (RF) of the medial branch of the dorsal ramus in patients with facet joint pain depends on the effective coagulation distance. To date, computed tomography(CT)-guided techniques do not reach the nerve in parallel but rather than punctually. We report a new CT-guided technique to enhance parallelism and proximity of the RF needle to the nerve. MATERIALS AND METHODS Two examiners with different experience with CT-guided procedures in corpses performed all punctures at the lumbar spine on 10 corpses. A RF needle was inserted 1 cm lateral to the spinous process of the vertebra located caudal to the target nerve. The needle was advanced under CT guidance at a flat angle between the superior articular process and the base of the costal or transverse process of the cranial vertebra. The position was verified by dissection. Needle position was judged successful provided the needle could be positioned in the first attempt with no more than one angle correction. RESULTS In 86 out of 100 possible cases (50 per side) at the 5 lumbar segments, the RF needle could be depicted by CT in the target area with no more than one correction of the needle position. Anatomical dissections revealed that 47 out of 86 needles (54.6%) fulfilled the requirements of parallelism and proximity to the nerve. The dorsal ramus was never reached by the RF needle. Higher success rates were obtained in the middle segments compared to the border segments of L1-L2 and L5-S1. CONCLUSIONS We could demonstrate that the principle of parallelism and proximity of the needle to the nerve could be fulfilled with this new technique; however, needle positioning requires practice due to the oblique puncture direction.
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Affiliation(s)
- G C Feigl
- Institut für makroskopische und klinische Anatomie, Medizinische Universität Graz, Harrachgasse 21, 8010, Graz, Österreich.
| | - C Mattersberger
- Institut für makroskopische und klinische Anatomie, Medizinische Universität Graz, Harrachgasse 21, 8010, Graz, Österreich
| | - W Rosmarin
- Institut für makroskopische und klinische Anatomie, Medizinische Universität Graz, Harrachgasse 21, 8010, Graz, Österreich
| | - R Likar
- Abteilung für Anästhesie und Intensivmedizin, LKH Klagenfurt, Klagenfurt, Österreich
| | - C Avila González
- Klinik für Anästhesiologie, Intensiv‑, Palliativ- und Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland
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Giraudet G, Lucot JP, Sanz F, Rubod C, Collinet P, Cosson M. Outpatient vaginal hysterectomy: Comparison of conventional suture ligature versus electrosurgical bipolar vessel sealing. J Gynecol Obstet Hum Reprod 2017; 46:399-404. [PMID: 28934083 DOI: 10.1016/j.jogoh.2017.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/17/2017] [Accepted: 03/23/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate the feasibility of vaginal hysterectomy in an ambulatory care system and the best way to perform it between conventional and bipolar vessel sealing system ligatures. PATIENTS AND METHODS This was a prospective study of 32 patients with vaginal hysterectomy at Lille University Hospital between December 2013 and May 2015. Two surgical techniques were compared: conventional suture ligature (CSL) and electrosurgical bipolar vessel sealing (BVS). Patients stayed in classical hospitalization but were managed how if they were in an ambulatory unit to evaluate their capacity to come back home the same evening of the surgery. The evaluation of same-day discharge was based on Post Anesthetic Discharge Scoring System (PADSS) score?9/10 and Visual Analogic Scale (VAS) score?4/10. Other data collected were: operative time, uterus weight, peroperative bleeding, PADSS score at the 8th postoperative hour, VAS score at the 4th, 6th, 8th, 12th and 24th postoperative hours, the presence of postoperative nausea/vomiting and rehospitalization. RESULTS In the BVS group, 93.8% of patients validated the combined score (PADSS+VAS) on the evening of the intervention against 50% of patients in the CSL group (P<0.05). Hundred percent of BVS group patients were discharged on the day after surgery against 87.5% in the CSL group. The VAS was significantly lower in the BVS group at the 8th (1.4), 12th (1.2) and 24th (1.3) postoperative hours. Operative time was significantly shorter in the BVS group. We found more events such as nausea/vomiting in the CSL group. CONCLUSION Vaginal hysterectomy is feasible in an ambulatory care system most of times. By reducing postoperative pain, electrosurgical bipolar vessel sealing would promote outpatient hospitalization.
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Affiliation(s)
- G Giraudet
- Department of Gynecological Surgery, Jeanne-de-Flandre Hospital, Regional University Hospital of Lille, avenue Eugène-Avinée, 59000 Lille, France.
| | - J P Lucot
- Department of Gynecological Surgery, Jeanne-de-Flandre Hospital, Regional University Hospital of Lille, avenue Eugène-Avinée, 59000 Lille, France; Department of Gynecology and Obstetrics, Hospital of Bethune, 27, rue Delbecque, 62131 Verquigneul, France
| | - F Sanz
- Department of Anesthesiology in Obstetrics, Gynecology and Reproductive Medicine, Jeanne-de-Flandre Hospital, avenue Eugène-Avinée, 59000 Lille, France; Department of anesthesia, groupement des hôpitaux de l'institut catholique de Lille, hôpital Saint-Philibert, rue du Grand-But, 59160 Lomme, France
| | - C Rubod
- Department of Gynecological Surgery, Jeanne-de-Flandre Hospital, Regional University Hospital of Lille, avenue Eugène-Avinée, 59000 Lille, France
| | - P Collinet
- Department of Gynecological Surgery, Jeanne-de-Flandre Hospital, Regional University Hospital of Lille, avenue Eugène-Avinée, 59000 Lille, France
| | - M Cosson
- Department of Gynecological Surgery, Jeanne-de-Flandre Hospital, Regional University Hospital of Lille, avenue Eugène-Avinée, 59000 Lille, France
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Herta J, Wang WT, Höftberger R, Breit S, Kneissl S, Bergmeister H, Ferraz-Leite H. An experimental animal model for percutaneous procedures used in trigeminal neuralgia. Acta Neurochir (Wien) 2017; 159:1341-8. [PMID: 28397136 DOI: 10.1007/s00701-017-3162-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 03/27/2017] [Indexed: 10/29/2022]
Abstract
OBJECT This study describes an experimental rabbit model that allows the reproduction of percutaneous operations that are used in patients with trigeminal neuralgia (TN). Attention was given to an exact anatomical description of the rabbit's middle cranial fossa as well as the establishment of conditions for a successful procedure. METHODS Morphometric measurements were taken from 20 rabbit skulls and CT scans. The anatomy of the trigeminal nerve, as well as its surrounding structures, was assessed by bilateral dissection of 13 New Zealand white rabbits (NWR). An ideal approach of placing a needle through the foramen ovale to reach the TG was sought. Validation of correct placement was realized by fluoroscopy and confirmed by dissection. RESULTS Precise instructions for successful reproduction of percutaneous procedures in NWR were described. According to morphological measurements, for balloon compression of the trigeminal ganglion (TG) the maximal diameter of an introducing cannula is 1.85 mm. The diameter of an empty balloon catheter should not exceed 1.19 mm, and the length of the inflatable part of the balloon can range up to 4 mm. For thermocoagulation the needle electrodes must not exceed an external diameter of 1.39, mm and the length of the non-insolated tip can range up to 4 mm. Glycerol rhizolysis can be achieved because the trigeminal cistern in the NWR is a closed space that allows a long dwelling time (>10 min) of the contrast agent. CONCLUSIONS An experimental NWR model intended for the reproduction of percutaneous procedures on the TG has been meticulously described. This provides a tool that enables further standardized animal research in the field of surgical treatment of TN.
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Viviano M, Kenfack B, Catarino R, Tincho E, Temogne L, Benski AC, Tebeu PM, Meyer-Hamme U, Vassilakos P, Petignat P. Feasibility of thermocoagulation in a screen-and-treat approach for the treatment of cervical precancerous lesions in sub-Saharan Africa. BMC Womens Health 2017; 17:2. [PMID: 28061842 PMCID: PMC5219781 DOI: 10.1186/s12905-016-0355-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/08/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND The use of thermocoagulation for the treatment of cervical precancerous lesions has recently generated a great deal of interest. Our aim was to determine the feasibility of this outpatient procedure in the context of a cervical cancer (CC) screen-and-treat campaign in sub-Saharan Africa. METHODS Between July and December 2015, women living in the area of Dschang (Cameroon) aged between 30 and 49 years, were enrolled in a CC screening study. HPV self-sampling was performed as a primary screening test and women who were either "HPV 16/18/45-positive" or "positive to other HPV types and to VIA" were considered screen-positive, thus requiring further management. The primary outcome was the percentage of screen-positive patients who met the criteria to undergo thermocoagulation. The secondary outcome was the assessment of the procedure's side effects immediately after treatment and at the 1-month follow-up visit. RESULTS A total of 1012 women were recruited in the study period. Among 121 screen-positive women, 110 of them (90.9%) were eligible to be treated with thermocoagulation. No patients discontinued treatment because of pain or other side effects. The mean ± SD (Standard Deviation) score measured on the 10-point Visual Analogue Scale (VAS) was 3.0 ± 1.6. Women having less than 2 children were more likely to report a higher pain score than those with more than two (4.2 ± 2.0 versus 2.9 ± 1.5, respectively; p value = 0.016). A total of 109/110 (99.1%) patients came to the 1-month follow-up visit. Vaginal discharge was reported in 108/109 (99.1%) patients throughout the month following treatment. Three patients (2.8%) developed vaginal infection requiring local antibiotics. No hospitalizations were required. CONCLUSION The majority of screen-positive women met the criteria and could be treated by thermocoagulation. The procedure was associated to minor side effects and is overall feasible in the context of a CC screen-and-treat campaign in sub-Saharan Africa. TRIAL REGISTRATION The trial was retrospectively registered on November 11, 2015 with the identifier: ISRCTN99459678 .
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Affiliation(s)
- Manuela Viviano
- Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland. .,Division of Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, 1205, Geneva, Switzerland.
| | - Bruno Kenfack
- Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon
| | - Rosa Catarino
- Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Eveline Tincho
- Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon
| | - Liliane Temogne
- Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon
| | - Anne-Caroline Benski
- Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.,Saint Damien Medical Centre, Ambanja, Madagascar
| | - Pierre-Marie Tebeu
- Department of Gynecology and Obstetrics, University Centre Hospital, Yaoundé, Cameroon
| | - Ulrike Meyer-Hamme
- Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Patrick Petignat
- Division of Gynaecology, Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
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13
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Naud PSV, Muwonge R, Passos EP, Magno V, Matos J, Sankaranarayanan R. Efficacy, safety, and acceptability of thermocoagulation for treatment of cervical intraepithelial neoplasia in a hospital setting in Brazil. Int J Gynaecol Obstet 2016; 133:351-4. [PMID: 27005927 DOI: 10.1016/j.ijgo.2015.09.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/24/2015] [Accepted: 02/15/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the acceptability, safety, and effectiveness of thermocoagulation for the treatment of histologically proven cervical intraepithelial neoplasia grade 2-3 (CIN2-3) lesions. METHODS In a retrospective study, data were obtained for women treated for CIN2-3 lesions by thermocoagulation at the Hospital de Clínicas de Porto Alegre, Brazil, between March 6, 2012, and October 29, 2013, and followed up after 1 year. The proportions of women with no evidence of disease, adverse effects, or complications were determined. RESULTS Among 52 women included, 44 (85%) had no evidence of disease 1year after thermocoagulation. The rate of no disease at follow-up was similar for women treated for CIN2 (17/20 [85%]) and CIN3 (27/32 [84%]). No serious adverse effects or complications requiring hospitalization were observed during the follow-up period. CONCLUSION Thermocoagulation is useful in the management of ectocervical CIN and should be integrated into public health services for management of cervical cancer.
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Affiliation(s)
- Paulo S V Naud
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Richard Muwonge
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Eduardo P Passos
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Valentino Magno
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jean Matos
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Rengaswamy Sankaranarayanan
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France.
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14
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Pacetti M, Fiaschi P, Gennaro S. Percutaneous radiofrequency thermocoagulation of dorsal ramus branches as a treatment of "lumbar facet syndrome"--How I do it. Acta Neurochir (Wien) 2016; 158:995-8. [PMID: 26979181 DOI: 10.1007/s00701-016-2759-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 02/24/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Low back pain is an extremely common and often chronic condition. In some cases, this is due to an irritative arthropathy of zygapophyseal joint involving the medial branch of the dorsal ramus of the spinal nerve. Percutaneous radiofrequency thermocoagulation appears to be the most effective treatment to date, among a range of different treatments. In this paper, the technique is described as performed at out institution. METHODS In supine position and under fluoroscopic control, a radiofrequency electrode is inserted into different articular zygapophyseal complexes to thermocoagulate ramifications of the medial branch of the dorsal primary ramus of the spinal nerve. CONCLUSIONS Fluoroscopic-guided percutaneous radiofrequency thermocoagulation of dorsal rami branches is a safe and reliable technique for the treatment of lumbar facet syndrome. Careful selection of patients based on clinical presentation and positive anesthetic block test are key points for an optimum outcome.
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Affiliation(s)
- Mattia Pacetti
- School of Neurosurgery, IRCCS Ospedale San Martino- IST, Università di Torino, Università degli studi di Genova, Genoa, Italy.
| | - Pietro Fiaschi
- School of Neurosurgery, IRCCS Ospedale San Martino- IST, Università di Torino, Università degli studi di Genova, Genoa, Italy
| | - Sergio Gennaro
- U.O. Neurochirurgia, IRCCS Ospedale San Martino- IST, Genoa, Italy
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15
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Yi X, Wei L, Liu Y, Long Q, Liu W, Fei Z, Liu Y, Yan L, He G, Zhang M, Zhou X. Efficacy of radio frequency thermocoagulation in surgery for giant supratentorial meningiomas: a historical control study. Clin Neurol Neurosurg 2015; 130:26-32. [PMID: 25576882 DOI: 10.1016/j.clineuro.2014.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/12/2014] [Accepted: 12/20/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Surgery for giant meningiomas carries a high risk of bleeding and is time-consuming. This historical control study tests the hypothesis that the use of radio frequency thermocoagulation (RFT) during surgery improves outcome. METHODS From November 2010 to October 2011, 20 giant vascularized meningiomas were surgically resected with intraoperative use of ultrasound-guided RFT prior to resection. The historical control group consisted of 25 patients in whom tumors were removed without RFT by the same surgical team. Blood loss during resection, changes in tumor consistency, time taken for the operation, and the extent of resection were compared between the two groups. RESULTS There was less blood lost during resection and the duration of the operation was shorter in RFT-assisted surgery than in the historical control group (P<0.05). Apart from the effect of devascularization, the tumor consistency became soft after RFT, which could also be beneficial. CONCLUSIONS Satisfactory devascularization and tumor softening were achieved after RFT without incremental complications. RFT-assisted surgery for giant vascularized supratentorial meningiomas is easier and safer than non-RFT surgery.
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Affiliation(s)
- Xicai Yi
- Department of Neurosurgery, Xijing Institute of Clinical Neuroscience, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Lizhou Wei
- Department of Neurosurgery, Xijing Institute of Clinical Neuroscience, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Yuanyang Liu
- The Health Team of 92872nd Troops, Chinese People' Liberation Army, China
| | - Qianfa Long
- Department of Neurosurgery, The Central Hospital of Xi'an, Xi'an, China
| | - Weiping Liu
- Department of Neurosurgery, Xijing Institute of Clinical Neuroscience, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
| | - Zhou Fei
- Department of Neurosurgery, Xijing Institute of Clinical Neuroscience, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
| | - Yang Liu
- Department of Neurosurgery, The Third Hospital of Mianyang, Mianyang, China
| | - Li Yan
- Department of Ultrasonography, The Central Hospital of Xi'an, Xi'an, China
| | - Guangbin He
- Department of Ultrasonography, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Miaomiao Zhang
- Department of Ultrasonography, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Xiaodong Zhou
- Department of Ultrasonography, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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16
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Ramos-Pascua LR, Martínez-Valderrábano V, Santos-Sánchez JA, Tijerín Bueno M, Sánchez-Herráez S. Radiofrequency thermal ablation of osteoid osteomas of the proximal femur. Usefulness of ultrasound guidance in selected cases. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 59:326-32. [PMID: 25532908 DOI: 10.1016/j.recot.2014.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/09/2014] [Accepted: 11/13/2014] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To review symptoms and imaging findings of proximal femoral osteoid osteomas (OO); to analyse the results of a thermal ablation technique for radiofrequency of the nidus in this location; and to describe usefulness of ultrasound guidance in selected cases. MATERIAL AND METHOD Descriptive and retrospective study consisting of 8 patients with OO in the proximal epiphysis of the femur, which were treated by thermal ablation of the nidus with radiofrequency waves from 1998 to 2004. RESULTS The mean pain period until the performance of the thermal ablation was 11.5 months (range 5-18 months). There were no complications, and all patients stated that the pain was gone by the day following the procedure, with some discomfort during the first week, except for one where it lasted more than one month due to technique difficulties. At present, with a mean follow up of 6 years and 2 months (range 6-190 months), all patients remain asymptomatic and live a rigorous normal life. DISCUSSION Thermal ablation with CT-guided radiofrequency waves is a safe, effective and efficient procedure. CONCLUSION Normal appearance of a proximal femoral OO does not differ significantly from other location osteomas and its diagnosis is easier with previous knowledge. Thermal ablation of the nidus with radiofrequency waves, that may be performed using ultrasound guidance, appears to be the elective treatment of choice due to its efficiency and minimum morbidity.
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Affiliation(s)
- L R Ramos-Pascua
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León, Gerencia Regional de Salud de Castilla y León (SACYL), León, España.
| | - V Martínez-Valderrábano
- Servicio de Radiología, Complejo Asistencial Universitario de León, Gerencia Regional de Salud de Castilla y León (SACYL), León, España
| | - J A Santos-Sánchez
- Servicio de Radiología, Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), Salamanca, España
| | - M Tijerín Bueno
- Servicio de Radiología, Complejo Asistencial Universitario de León, Gerencia Regional de Salud de Castilla y León (SACYL), León, España
| | - S Sánchez-Herráez
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León, Gerencia Regional de Salud de Castilla y León (SACYL), León, España
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Bourgault C, Vervoort T, Szymanski C, Chastanet P, Maynou C. Percutaneous CT-guided radiofrequency thermocoagulation in the treatment of osteoid osteoma: a 87 patient series. Orthop Traumatol Surg Res 2014; 100:323-7. [PMID: 24679368 DOI: 10.1016/j.otsr.2014.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 01/06/2014] [Accepted: 02/10/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Osteoid osteoma is a painful, benign bone tumor that mainly affects young people. Thermocoagulation is one of the recommended percutaneous treatment methods. This study sought to assess its efficacy and identify risk factors for osteoma recurrence. METHODS Results were analyzed retrospectively for a group of 87 patients treated by thermocoagulation between 2002 and 2011. The recurrence rate was calculated and analyzed relative to patient and tumor characteristics. The treatment efficacy was determined and methods to prevent complications were analyzed. RESULTS The mean follow-up time was 34 months. The average patient age was 23 years. There were seven complications including three patients with delayed wound healing, mainly at tibial sites. The recurrence rate was 10.4%. The success rate for first-line treatment was 89.6% and it was 97.5% for second-line treatment. Analysis of patient characteristics and tumor locations revealed no risk factors for recurrence. CONCLUSION Percutaneous thermocoagulation is a reliable and effective technique that provides fast, long-lasting pain relief. However recurrence can occur even after the nidus is completely resected. These recurrences can be effectively managed by repeat treatment. Recent technical improvements have reduced the risk of thermocoagulation-related complications. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- C Bourgault
- CHRU de Lille, Orthopedics Unit A, rue du Pr-Emile-Laine, 59037 Lille cedex, France.
| | - T Vervoort
- CHRU de Lille, Orthopedics Unit A, rue du Pr-Emile-Laine, 59037 Lille cedex, France
| | - C Szymanski
- CHRU de Lille, Orthopedics Unit A, rue du Pr-Emile-Laine, 59037 Lille cedex, France
| | - P Chastanet
- Radiology and Musculoskeletal Imaging Department, CHRU de Lille, rue du Pr-Emile-Laine, 59037 Lille cedex, France
| | - C Maynou
- CHRU de Lille, Orthopedics Unit A, rue du Pr-Emile-Laine, 59037 Lille cedex, France
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Son BC, Kim HS, Kim IS, Yang SH, Lee SW. Percutaneous radiofrequency thermocoagulation under fluoroscopic image-guidance for idiopathic trigeminal neuralgia. J Korean Neurosurg Soc 2011; 50:446-52. [PMID: 22259692 DOI: 10.3340/jkns.2011.50.5.446] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 08/26/2011] [Accepted: 11/21/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We retrospectively investigated the long-term results of percutaneous radiofrequency thermocoagulation (RFT) using fluoroscopic image-guidance for treatment of trigeminal neuralgia. METHODS A total of 38 patients diagnosed and treated with RFT as an idiopathic trigeminal neuralgia were investigated. To minimize the risks related to conventional technique based on cutaneous landmarks, and to eliminate the need to frequent reposition of cannula, we adopted a technique of image-guided fluoroscopic cannulation of the foramen ovale. To minimize sensory complication following thermal lesion, our target response was a generation of a lesion with mild to moderate hypalgesia rather than dense hypalgesia. RESULTS The immediate pain-relief was achieved in all patients underwent RFT. With mean duration of follow-up of 38.2 months (range,12-72), 11 (28.9%) experienced recurrence of pain. The mean timing of recurrence was 26.1 months (range,12-46). A 42.7% recurrence rate was estimated by Kaplan-Meier analysis for the 38 patients at 46 months; 20.2% within 2 years, 29.1% within 3 years. In the long-term, 27 patients (71%) and 6 patients (15.8%) showed Barrow Neurological Institute (BNI) score I and BNI score II responses. 3 (7.9%) patients was assessed as BNI score III, 2 patients (5.3%) showed BNI score IV response. As a complication, troublesome dysesthesia occurred in 3 of 38 patients (7.9%), however, there was no permanent cranial nerve palsy or morbidity. CONCLUSION These results indicates that RFT under fluoroscopic image-guided cannulation of foramen ovale is a safe, effective, and reliable means of treating trigeminal neuralgia.
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Affiliation(s)
- Byung-Chul Son
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, College of Medicine, Suwon, Korea
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