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Poullet Z, Redon S, Gravier-Dumonceau R, Donnet A. "Status trigeminal neuralgia": Analysis of 39 cases and proposal for diagnostic criteria. Rev Neurol (Paris) 2024:S0035-3787(24)00523-X. [PMID: 38789382 DOI: 10.1016/j.neurol.2024.03.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE The aim of this descriptive study was to propose diagnostic criteria for acute exacerbation of trigeminal neuralgia (TN) based on the analysis of retrospective cases. BACKGROUND TN is a rare and extremely painful condition whose evolution can be punctuated by major exacerbations, leading to significant functional impairment. Several denominations are used for these exacerbations: "acute exacerbation", "status of trigeminal neuralgia", and "status trigeminus". There is currently no clinical definition of this state. In this manuscript, we used the term "status trigeminal neuralgia" (STN). METHODS We conducted a retrospective study, in a tertiary care specialist headache center, in France. Patients were selected from January 2015 to October 2022, with the French translation of the keyword "STN", in the medical records (outpatients) or the codage for trigeminal neuralgia (inpatients). Additional cases of STN were prospectively recruited from October 2022 to February 2023. We analyzed the clinical and paraclinical data of these patients. RESULTS Thirty-nine patients presenting with STN were included. There was a preponderance of women (64%) with 24 cases of classic TN (62%) and 15 cases of secondary TN (38%). Concerning STN, 39 episodes were described. Pain was very severe in all patients. Cranial autonomic signs were present in 23% of cases. Pain extended beyond the usual territory in 44% of cases. A continuous pain background was present in 35% of cases. With regard to triggering factors, paroxysms of facial pain were triggered by eating (97% of patients), speaking (90%) or drinking (62% of patients). Repercussions on weight, hydration, or mood disorders were observed in 67%, 56% and 59% of the cases, respectively. CONCLUSION STN is a rare clinical presentation of TN. We proposed criteria and a new denomination for this condition.
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Affiliation(s)
- Z Poullet
- Department of Evaluation and Treatment of Pain, FHU INOVPAIN, CHU Timone, AP-HM, Marseille, France
| | - S Redon
- Department of Evaluation and Treatment of Pain, FHU INOVPAIN, CHU Timone, AP-HM, Marseille, France.
| | - R Gravier-Dumonceau
- APHM, INSERM, IRD, SESSTIM, sciences economiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Hop Timone, BioSTIC, biostatistique et technologies de l'information et de la communication, Aix Marseille Univ, Marseille, France
| | - A Donnet
- Department of Evaluation and Treatment of Pain, FHU INOVPAIN, CHU Timone, AP-HM, Marseille, France; Inserm U-1107, CHU de Clermont-Ferrand, Clermont-Ferrand, France
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SohrabiAsl M, Shirani M, Jahanbakhshi A, Iranmehr A. Efficacy and Challenges: Minimally Invasive Procedures for Trigeminal Neuralgia Treatment in Multiple Sclerosis - A Systematic Review and Meta-Analysis. Stereotact Funct Neurosurg 2024:1-13. [PMID: 38648730 DOI: 10.1159/000538516] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/14/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Trigeminal neuralgia (TGN) poses a therapeutic challenge, particularly within the context of multiple sclerosis (MS). This study aimed to conduct a comprehensive meta-analysis and systematic review of four less-invasive treatment modalities for TGN in MS patients, namely, gamma knife radiosurgery (GKRS), glycerol rhizotomy (GR), balloon compression (BC), and radiofrequency ablation (RFA). METHODS Single-armed meta-analyses were employed to assess the overall efficacy of each treatment, while double-armed analyses compared the efficacy between different treatment options in double-armed studies. Outcome evaluations included acute pain relief (within 1 month post-procedure), recurrence rates throughout 18 months of follow-up, and reported complication rates. RESULTS The meta-analysis revealed diverse outcomes for each intervention. GKRS demonstrated favorable outcomes, achieving a 77% success rate in alleviating pain among a pooled cohort of 863 patients, reinforcing its status as a viable therapeutic option. Additionally, GR, BC, and RFA exhibited efficacy, with success rates of 77%, 71%, and 80%, respectively, based on outcomes observed in 611, 385, and 203 patients. Double-armed analyses highlighted distinctions between the treatments, providing nuanced insights for clinical decision-making. CONCLUSION This meta-analysis provides a comprehensive overview of less-invasive treatments for TGN in MS patients. GKRS emerges as a leading option with comparable efficacy and fewer complications. However, the study underscores the nuanced efficacy and considerations associated with GR, BC, and RFA. The findings offer valuable insights for clinicians navigating treatment choices in this challenging patient population, considering acute pain relief, recurrence rates, and complication profiles.
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Affiliation(s)
- Masoud SohrabiAsl
- Neurosurgery Department, Tabriz University of Medical Sciences, Tabriz, Iran,
| | - Mohammad Shirani
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Amin Jahanbakhshi
- Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Arad Iranmehr
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Gamma-Knife Center, Yas Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Valerio Pascua JE, Mantilla Farfan P, Fernandez MP, Santiago Rea N, Borro M, Alvarez-Pinzon AM. Frame navigation guided percutaneous balloon compression for intractable trigeminal neuralgia secondary to multiple sclerosis. Brain Spine 2024; 4:102798. [PMID: 38596449 PMCID: PMC11002796 DOI: 10.1016/j.bas.2024.102798] [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] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/25/2024] [Accepted: 03/30/2024] [Indexed: 04/11/2024]
Abstract
Background Patients with multiple sclerosis (MS) are more likely to develop trigeminal neuralgia (TN) compared to the regular population, due to scarring of the nerve and development of a demyelination plaque. Despite treatment, approximately 10% of MS patients treated for TN experience symptom recurrence, including the development of MS-like symptoms such as optic neuritis and bilateral facial pain. Methods A computed tomography (CT) scan was performed preoperatively on two patients diagnosed with multiple sclerosis (MS) who experienced secondary trigeminal neuralgia (TN). A precise reference frame was strapped firmly to the patient's forehead during the intraoperative procedure. Preliminary CT images were registered using the navigation system and the bony landmarks were set. Case description Two patients diagnosed with multiple sclerosis (MS) who experienced refractory trigeminal neuralgia (TN) underwent percutaneous balloon compression. Initial conservative treatment and one dosage of Gamma Knife Radiosurgery (GKR) resulted in symptom control for a few weeks. Both patients had an acute recurrence of pain; thus, percutaneous retrogasserian balloon compression was performed. During follow-up, the patients reported a 70% decrease in pain after the procedure, with minimal recurrence of shooting episodes. Conclusion Management of trigeminal neuralgia secondary to drug-resistant multiple sclerosis presents a persistent challenge. The percutaneous technique for retrogasserian balloon compression may offer a solution for some patients, but it presents unique challenges for neurosurgeons. Given the complexity of the pathogenesis, target identification, and the potential absence of neurovascular conflict, microvascular decompression remains a debated approach for this patient population. While stereotactic radiosurgery may be a promising alternative.
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Affiliation(s)
- Jose E. Valerio Pascua
- Neurosurgery Oncology, Neurosurgery Oncology Center of Excellence at Miami Neuroscience Center, Larkin Healthcare System, Miami, FL, USA
- Neurological Surgery, Palmetto General Hospital at Steward Family Hospital, Hialeah, FL, USA
- Neurological Surgery, Latinoamerica Valerio Foundation, Weston, FL, USA
| | | | - Maria Paula Fernandez
- Neurological Surgery, Palmetto General Hospital at Steward Family Hospital, Hialeah, FL, USA
| | - Noe Santiago Rea
- Neurological Surgery, Palmetto General Hospital at Steward Family Hospital, Hialeah, FL, USA
| | - Matteo Borro
- Neurological Surgery, Palmetto General Hospital at Steward Family Hospital, Hialeah, FL, USA
| | - Andres M. Alvarez-Pinzon
- Neurological Surgery, Latinoamerica Valerio Foundation, Weston, FL, USA
- Stanford Graduate School of Business, 655 Knight Way, Stanford, CA, 94305, USA
- Institute of Neuroscience of Castilla and Leon (INCYL), University of Salamanca (USAL), Salamanca, Spain
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Abstract
BACKGROUND Percutaneous balloon compression is a safe and effective treatment for trigeminal neuralgia. Current technique consists of penetrating the foramen ovale using a sharp 14G needle with a stylet. Difficulty of cannulation of the foramen ovale, failures of cannulation and major neurovascular complications of the procedure, although rare, may be due to the relatively large caliber of this needle and its sharp tip. OBJECTIVE To present a novel technique to facilitate and make the cannulation of the foramen ovale with a 14G cannula safer. METHODS A rigid blunt-tip guide of 1.2 or 1.5 mm is used to penetrate the foramen ovale under lateral fluoroscopic control. Once the guide enters the foramen it is advanced further to the clival line, and a 14G cannula is then advanced over the guide to engage the foramen, at which point the guide is withdrawn and replaced with the balloon catheter. RESULTS The technique was employed to deliver a 4F balloon catheter to Meckel's cave successfully in 500 consecutive procedures performed on 416 trigeminal neuralgia patients. None of the patients had neurovascular complications like facial hematoma, arterial injury, carotid-cavernous fistula or cranial nerve palsies. CONCLUSION A novel technique for cannulation of the foramen ovale is described. The use of blunt tip guides of smaller diameters instead of sharp 14 G needles considerably facilitated cannulation of the foramen ovale and enabled cannulation in all cases. Absence of complications of cannulation such as facial hematoma, carotid-cavernous fistula or intracranial hemorrhage in this series of patients suggests that the technique may be safer than the use of conventional sharp tipped 14G needles in terms of avoiding neurovascular complications.
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Affiliation(s)
- Orhan Barlas
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tugrul Cem Unal
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Huang P, Liu H, Liu Z, Huang L, Lu M, Wang L, Yu Y, Jin X. Effectiveness of percutaneous balloon compression (PBC) in improving physical function and quality of life in trigeminal neuralgia: a retrospective study. Acta Neurochir (Wien) 2023; 165:3905-3912. [PMID: 37897680 DOI: 10.1007/s00701-023-05823-z] [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] [Received: 03/30/2023] [Accepted: 09/17/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of percutaneous balloon compression (PBC) in treating trigeminal neuralgia (TN) and determine improvements in quality of life (QoL) and daily functional status. METHODS Data from primary TN (pTN) patients treated with PBC from December 2018 to April 2021 were retrospectively analyzed. Short-Form 36 (SF-36) Health Survey and Functional Independence Measure (FIM) assessments were used to evaluate patients' QoL and physical function every 6 months after surgery, and facial pain was evaluated every 3 to 6 months post-surgery. RESULTS A total of 80 pTN patients were enrolled for analysis. The Barrow Neurological Institute (BNI) scores of I-II were achieved in 67 (83.8%) patients immediately after the surgery. The estimated rates of BNI I-II pain relief at one, two, and three years were 94.2%, 87.6%, and 83.2%, respectively. All aspects of the SF-36 questionnaire were significantly improved after the PBC, especially in terms of role physical (RP), bodily pain (BP), and social functioning (SF). Patients' functional outcomes measured by FIM at the 6-month follow-up examination were 108.6 ± 9.9, which was significantly improved compared with the pretreatment scores (90.8 ± 12.7). There was no difference between the severity of facial numbness in FIM and any item of the SF-36 except RP (P = 0.004) at 6 months after surgery. There was also no difference in SF-36 and FIM between patients with or without facial hyperalgesia. CONCLUSIONS PBC can produce long-term and stable pain relief and significantly improve the patient's QoL and physical function. However, further well-designed, high-level, evidence-based studies are needed to precisely assess the efficacy of PBC for pTN patients.
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Affiliation(s)
- Peng Huang
- Department of Anesthesiology and Pain, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hong Liu
- Department of Anesthesiology and Pain, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhenxiu Liu
- Department of Anesthesiology and Pain, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Liqun Huang
- Department of Anesthesiology and Pain, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Min Lu
- Department of Anesthesiology and Pain, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Lina Wang
- Department of Anesthesiology and Pain, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yaqiong Yu
- Department of Anesthesiology and Pain, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Xiaohong Jin
- Department of Anesthesiology and Pain, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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Xia Q, Huang H, Ma Y, Wang Q, Wang B, Jing F, Xu Y, Li Y, Zhou B. Relationship between compression time and long-term hypoesthesia in primary trigeminal neuralgia treated with percutaneous balloon compression. Neurosurg Rev 2023; 46:212. [PMID: 37642744 DOI: 10.1007/s10143-023-02124-y] [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] [Received: 05/26/2023] [Revised: 08/05/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
Percutaneous balloon compression is a surgical method for the treatment of trigeminal neuralgia, but one of the surgical parameters, compression time, is inconclusive. To investigate the effect of compression time during balloon compression on long-term postoperative hypoesthesia in patients with primary trigeminal neuralgia and to provide guidance on relevant parameters for balloon compression in the treatment of primary trigeminal neuralgia, we conducted a nested case-control study. Patients with primary trigeminal neuralgia treated by balloon compression from March 2013 to September 2013 were divided into case group and control group according to whether there were still symptoms of hypoesthesia at present. The relationship between the compression time of balloon compression and long-term hypoesthesia was analyzed. A total of 289 trigeminal neuralgia patients treated with percutaneous balloon compression were included in this study. Multivariate logistic regression showed that compression time was significantly correlated with long-term hypoesthesia (OR = 1.91, 95% CI = 1.13-3.23, P = 0.02), and compression time was greater than one. The risk of hypoesthesia in the long-term when the compression time is longer than 1 min is 1.93 times that of 1 min. PBC is a safe and effective surgical method, and the long-term hypoesthesia is related to the compression time during operation. The longer the compression time during operation, the greater the risk of long-term hypoesthesia.
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Affiliation(s)
- Qiu Xia
- Department of Clinical Epidemiology and Evidence-Based Medicine, The First Hospital of China Medical University, No. 155 Nanjing North Street, Shenyang, Liaoning, China
| | - Haitao Huang
- 2nd Department of Neurosurgery, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang, Liaoning, China
| | - Yi Ma
- 2nd Department of Neurosurgery, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang, Liaoning, China
| | - Quancai Wang
- 2nd Department of Neurosurgery, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang, Liaoning, China
| | - Bin Wang
- 2nd Department of Neurosurgery, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang, Liaoning, China
| | - Fangkun Jing
- 2nd Department of Neurosurgery, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang, Liaoning, China
| | - Yangxi Xu
- 2nd Department of Neurosurgery, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang, Liaoning, China
| | - Yanfeng Li
- 2nd Department of Neurosurgery, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenyang, Liaoning, China.
| | - Bo Zhou
- Department of Clinical Epidemiology and Evidence-Based Medicine, The First Hospital of China Medical University, No. 155 Nanjing North Street, Shenyang, Liaoning, China.
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Nascimento RFV, Pipek LZ, de Aguiar PHP. Is percutaneous balloon compression better than microvascular decompression to treat trigeminal neuralgia? A systematic review and meta-analysis. J Clin Neurosci 2023; 109:11-20. [PMID: 36634472 DOI: 10.1016/j.jocn.2023.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 08/25/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a neuropathic pain that affects one or more branches of the trigeminal nerve. Surgical options after pharmacological failure are Microvascular Decompression (MVD) or percutaneous procedures, which include Balloon Compression (PBC). This study aims to describe pain outcomes and complications after PBC and MVD procedures for patients with trigeminal neuralgia. METHODS We performed a systematic review and meta-analysis on PubMed, EMBASE, LILACS, and Web of Science databases up to April 2022, following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and meta-Analysis). Articles that separately describe pain outcome for MVD and PBC were included. MINORS tool was used for bias assessment. Meta-analysis results are presented in forest plot and funnel plot. RESULTS 853 studies were assessed for screening, and 11 studies met the inclusion criteria for this review. A total of 1046 patients underwent PBC and 1324 underwent MVD. The subgroup analysis for patients without multiple sclerosis shows that MVD was associated with lower number of patients with pain than PBC, with an OR value of 0.54 (95 % CI 0.34-0.84). All other analyses evidenced a tendency for better outcomes after the MVD procedure, but with no statistically significant difference. CONCLUSION Considering short and long pain relief, recurrence of pain and total complications for MVD and PBC, our study found that MVD is the best surgical option available for trigeminal neuralgia.
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Affiliation(s)
| | | | - Paulo Henrique Pires de Aguiar
- Department of Neurosurgery, Santa Paula Hospital, São Paulo, Brazil; Department of Research and Innovation, Laboratory of Cellular and Molecular Biology, FMABC, Santo André, São Paulo, Brazil; Department of Neurology, School of Medicine of Pontifical Catholic University of São Paulo, Sorocaba, São Paulo, Brazil; State Serviant Public Hospital, São Paulo, Brazil
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Leclerc A, Salkine MF, Emery E. Percutaneous balloon compression for trigeminal neuralgia: a how I do it. Acta Neurochir (Wien) 2022; 164:2939-2943. [PMID: 35585283 DOI: 10.1007/s00701-022-05242-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical treatments for trigeminal neuralgia may include percutaneous techniques including the balloon compression technique. We present here a simple, effective, and safe adaptation of the historical technique described by Mullan in 1978. METHOD Our procedure is performed in a bi-plane neuro-radiology room. During general anesthesia, 14-G needle is guided under radioscopy to foramen ovale. The 3-F embolectomy catheter is then inserted and inflated with contrast for a period of 2 min 15 s. CONCLUSION Our technique, performed entirely under bi-plane fluoroscopy, allows a quicker and more precise surgery and avoids errors in guiding the catheter that can result serious injury.
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Affiliation(s)
- Arthur Leclerc
- Department of Neurosurgery, CHU Caen, Avenue de La Côte de Nacre, 14000, Caen, France. .,Medical School, Université Caen Normandie, 14000, Caen, France.
| | | | - Evelyne Emery
- Department of Neurosurgery, CHU Caen, Avenue de La Côte de Nacre, 14000, Caen, France.,Medical School, Université Caen Normandie, 14000, Caen, France.,INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, 14000, Caen, France
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Oertel MF, Sarnthein J, Regli L, Stieglitz LH. Peroral Trigeminal Rhizotomy Using a Novel 3-Dimensional Printed Patient-Specific Guidance Tool. Oper Neurosurg (Hagerstown) 2021; 21:491-496. [PMID: 34460929 DOI: 10.1093/ons/opab299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/07/2021] [Accepted: 07/02/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Ganglion Gasseri rhizotomy is a viable therapeutic option for trigeminal pain (TP). For this neurosurgical procedure, different potential operative and technical nuances exist. OBJECTIVE To evaluate a novel peroral trigeminal rhizotomy method and 3-dimensional printed patient-specific guidance tool (3D-PSGT) with respect to their applicability and safety. METHODS Between March 2018 and February 2021, 20 peroral balloon compression rhizotomy procedures with a 3D-PSGT were performed in 18 consecutive TP patients (13 female, mean age 58 yr). We registered the procedure duration, side effects, complications, and trigeminal function. The therapeutic effect was gauged from reduction of TP and use of analgesics. RESULTS All catheter insertions and rhizotomy procedures were successful at the first attempt. Apart from fluoroscopy, no auxiliary material was necessary. The average length of surgery was 19 min (range, 11-27 min). In total, 8 patients indicated complete analgesia and 6 patients pain relief; in 4 patients, persistence of TP was observed during follow-up examinations of up to 20 mo. In total, 6 patients reported of new mild to moderate facial hypesthesia affecting the trigeminal branches V2, V3, or V1-3. No masticatory musculature or corneal affections and device-related complications occurred. CONCLUSION The peroral 3D-PSGT trigeminal rhizotomy is straightforward for the neurosurgeon. This operative approach allows for rapid, safe, and simple foramen ovale cannulation in TP patients and reduces the use of additional equipment, radiation exposure, and procedure time.
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Affiliation(s)
- Markus F Oertel
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Johannes Sarnthein
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lennart H Stieglitz
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Jain A, Ibrahim B, Ali A, Muhsen BA, Najera E, Adada B, Borghei-Razavi H, Obrzut M. Percutaneous balloon compression technique using intraoperative contrasted DynaCT for the treatment of refractory trigeminal neuralgia: initial experience. Neurosurg Rev 2021; 45:1393-1399. [PMID: 34599700 DOI: 10.1007/s10143-021-01649-4] [Citation(s) in RCA: 1] [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: 06/17/2021] [Revised: 08/24/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Percutaneous balloon compression (BC) is a well-established technique that can provide immediate relief to patients suffering from trigeminal neuralgia (TN). The general procedure of BC uses fluoroscopy imaging to guide the needle through the foramen ovale (FO). The aim of this study was to describe our experience with a novel technique using intraoperative contrast-enhanced DynaCT as an adjunct for more accurate and safer guidance of the needle to the FO. METHODS In this study, DynaCT was used to perform BC in 20 TN cases. The three-dimensional path of the needle was pre-planned using DynaCT obtained during the administration of IV contrast. The FO was accessed in a single pass along the path pre-determined from the DynaCT images, avoiding any major arteries and veins. DynaCT was also used for confirmation of the final position of the needle prior to insertion of the balloon as well as for confirmation of the position of the balloon after inflation. RESULTS Intravenous contrast-enhanced DynaCT-guided percutaneous BC allowed precise advancement and positioning of the needle within the FO. It facilitated cannulation of the FO along a pre-determined path that avoided any major vascular structures. Clinical outcomes were excellent-all patients had a quick postoperative recovery, and there were no complications. CONCLUSIONS The advantages of the contrast-enhanced DynaCT-guided technique include a single precise needle pass and avoidance of vessel injury. Precise placement of the balloon into different aspects of the FO can target trigeminal branches more selectively and allow for a better outcome.
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Affiliation(s)
- Aakangsha Jain
- Department of Neurosurgery, Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Bilal Ibrahim
- Department of Neurosurgery, Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Assad Ali
- Department of Neurosurgery, Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Baha'eddin A Muhsen
- Department of Neurosurgery, Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Edinson Najera
- Department of Neurosurgery, Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Badih Adada
- Department of Neurosurgery, Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Hamid Borghei-Razavi
- Department of Neurosurgery, Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
| | - Michal Obrzut
- Department of Neurosurgery, Braathen Neurological Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, 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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Texakalidis P, Xenos D, Karras CL, Rosenow JM. Percutaneous Surgical Approaches in Multiple Sclerosis-Related Trigeminal Neuralgia: A Systematic Review and Meta-analysis. World Neurosurg 2020; 146:342-350.e1. [PMID: 33171325 DOI: 10.1016/j.wneu.2020.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/26/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The prevalence of trigeminal neuralgia (TN) in the setting of multiple sclerosis (MS) is reported to be 20-fold higher than in the general population. In these patients, TN can be medically refractory and often requires neurosurgical interventions. Ablative percutaneous approaches such as balloon compression (BC), glycerol rhizolysis (GR), and radiofrequency ablation (RF) can be used and often provide rapid pain relief. The aim of this meta-analysis was to compare the safety and efficacy profile of these approaches. METHODS This study was performed according to the PRISMA guidelines. A random effects model meta-analysis was conducted. RESULTS Five studies with 481 percutaneous approaches were included. No differences in terms of immediate pain relief were identified between BC and GR (odds ratio [OR]: 0.94; 95% confidence interval [CI]: 0.52-1.71). BC was associated with statistically significant higher odds of postoperative mastication weakness compared to GR (OR: 8.58; 95% CI: 1.52-48.43). The rates of pain recurrence (OR: 1.19; 95% CI: 0.04-40.12), hypoesthesia (OR: 0.98; 95% CI: 0.51-1.87), and reduced corneal reflex (OR: 1.07; 95% CI: 0.18-6.17) were similar between BC and GR. In addition, no differences in terms of immediate pain relief (OR: 2.01; 95% CI: 0.77-5.27), pain recurrence (OR: 5.37; 95% CI: 0.30-97.43), and hypoesthesia (OR: 0.63; 95% CI: 0.02-17.66) were identified between RF and GR. The comparison between BC versus RF showed similar rates of immediate pain relief (OR: 0.50; 95% CI: 0.10-2.44), pain recurrence (OR: 1.04; 95% CI: 0-325.96), and hypoesthesia (OR: 2.63; 95%CI: 0.01-735.71). CONCLUSIONS No significant differences in the immediate pain relief rates between BC, GR, and RF in MS patients were found. However, BC was associated with a higher risk of postoperative mastication weakness compared with GR.
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Affiliation(s)
- Pavlos Texakalidis
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA.
| | - Dimitrios Xenos
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Joshua M Rosenow
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
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Asplund P, Linderoth B, Lind G, Winter J, Bergenheim AT. One Hundred Eleven Percutaneous Balloon Compressions for Trigeminal Neuralgia in a Cohort of 66 Patients with Multiple Sclerosis. Oper Neurosurg (Hagerstown) 2019; 17:452-459. [PMID: 30690631 DOI: 10.1093/ons/opy402] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/24/2018] [Accepted: 01/02/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Trigeminal neuralgia associated with multiple sclerosis (MS-TN) is comparatively rare and larger series of percutaneous balloon compression (PBC) in such cases are few in the literature. OBJECTIVE To evaluate the results after PBC for MS-TN with regards to therapeutic effect, side effects, and complications. METHODS One hundred eleven procedures with PBC performed in 66 cases of MS-TN were analyzed. Therapeutic effect was measured as postoperative time to pain recurrence without medication. All complications were compiled and the sensory function was evaluated in a subgroup of cases. RESULTS The initial pain free rate was 67% and the median time to pain recurrence was 8 mo. Thirty-six patients were treated with PBC only, and among them, the results were worse if treated 3 to 4 times before, compared to first treatment (P = .009-.034). Patients who had several PBCs had worse results already after the first surgery (P < .001). A significant number of patients had impaired sensation to light touch directly after surgery, which was normalized at the late follow-up. Sensimetric testing showed raised thresholds for perception and pain directly after surgery (P = .004-.03), but these were also normalized at the late follow-up. CONCLUSION PBC is a treatment that can be effective for many patients with MS-TN. Repeated previous surgeries is a risk factor for an unsatisfactory outcome. However, the patients with multiple surgeries had less satisfactory results already at the first procedure, indicating that a therapy resistant disease can be predicted after the first two PBCs. Postoperative sensory deficits were common but not lasting.
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Affiliation(s)
- Pär Asplund
- Department of Neurosurgery, Umeå University, Umeå, Sweden
| | - Bengt Linderoth
- Department of Clinical Neuroscience, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Göran Lind
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Jaleh Winter
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
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Jain A. Comparative Analysis of Balloon Compression and Radiofrequency Ablation in Idiopathic Trigeminal Neuralgia: A Retrospective Study with a 24-Month Follow-up. Turk J Anaesthesiol Reanim 2019; 47:146-150. [PMID: 31080957 DOI: 10.5152/tjar.2019.53533] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 05/22/2018] [Accepted: 09/04/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Trigeminal neuralgia (TN) is a common cause of facial pain, with a prevalence of 40 per million. This paper is a retrospective 24-month follow-up study of 20 patients with idiopathic drug-resistant TN who underwent balloon compression (BC) or radiofrequency ablation (RFA). Methods When neuralgia affected more than one divisions or it involved ophthalmic division, BC was performed. RFA was performed in neuralgia involving isolated mandibular or maxillary division. Results At all the time points, numerical rating score (NRS) was lower in the BC group, but the difference was not significant. The proportion of patients developing recurrence of pain was lower in the BC group, but the difference was not significant (p-value 0.63). The proportion of patients requiring a repeat procedure was lower in the BC group, but the difference was not significant. There was no significant correlation among recurrence of pain, age of the patient and number of divisions in which neuralgia was present. In BC, a pear shape of the balloon is desirable, but this shape is not always achievable. Recurrence of pain in the BC group was comparable to that in the available literature, but the recurrence rate in the RFA group was comparatively higher. The complications in BC were higher, but they were transient and improved with time. Conclusion BC and RFA are effective modalities of treatment for idiopathic TN with comparable results. In TN involving multiple divisions, BC may be more convenient.
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Affiliation(s)
- Anuj Jain
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bhopal, India
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Murgoci AN, Baciak L, Cubinkova V, Smolek T, Tvrdik T, Juranek I, Kafka J, Cizkova D. Diffusion Tensor Imaging: Tool for Tracking Injured Spinal Cord Fibres in Rat. Neurochem Res 2019; 45:180-187. [PMID: 31055738 DOI: 10.1007/s11064-019-02801-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/03/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 01/26/2023]
Abstract
Spinal cord injury (SCI) is a severe disorder of the CNS leading to tissue damage and disability. Because it is critical to understand the pathological processes, it is important to find efficient ways to diagnose the severity of injured spinal cord tracts in situ from beginning up to a certain level of recovery following therapeutic interventions. In the current study, we set-up the criteria for diffusion tensor imaging (DTI) in order to capture changes of nerve fibre tracts in rat spinal cord compression injury. We tested four DTI parameters, such as fractional anisotropy, mean diffusivity, axial diffusivity and radial diffusivity at the lesion site, in time course of 7 weeks. Afterwards, we compared DTI data with histological results and locomotor outcomes to examine their consistency and capability of reflecting the lesion development in time. Our data confirm that DTI is a valuable in vivo imaging tool capable to distinguish damaged white matter tracts after mild SCI in rat. Fractional anisotropy showed decreased values for injury site, while the mean diffusivity had higher values, with increased both axial and radial diffusivity in comparison to control subjects. Thus, the combination of DTI parameters can reflect the severity of lesion in time and may correlate with histological evaluation of spared tissue, but not with locomotor recovery following mild injury associated with spontaneous recovery.
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Affiliation(s)
- Adriana-Natalia Murgoci
- Institute of Neuroimmunology, Slovak Academy of Sciences, Dúbravská cesta 9, 845 10, Bratislava, Slovakia
| | - Ladislav Baciak
- Central Laboratories, Slovak University of Technology, 812 37, Bratislava, Slovakia
| | - Veronika Cubinkova
- Institute of Neuroimmunology, Slovak Academy of Sciences, Dúbravská cesta 9, 845 10, Bratislava, Slovakia
| | - Tomas Smolek
- Institute of Neuroimmunology, Slovak Academy of Sciences, Dúbravská cesta 9, 845 10, Bratislava, Slovakia
| | - Tomas Tvrdik
- Central Laboratories, Slovak University of Technology, 812 37, Bratislava, Slovakia
| | - Ivo Juranek
- Institute of Experimental Pharmacology and Toxicology, CEM of the SAS, 841 04, Bratislava, Slovakia
| | - Jozef Kafka
- Department of Anatomy, Histology and Physiology, University of Veterinary Medicine and Pharmacy in Košice, Komenského 73, Kosice, 041 81, Slovakia
| | - Dasa Cizkova
- Institute of Neuroimmunology, Slovak Academy of Sciences, Dúbravská cesta 9, 845 10, Bratislava, Slovakia. .,Department of Anatomy, Histology and Physiology, University of Veterinary Medicine and Pharmacy in Košice, Komenského 73, Kosice, 041 81, Slovakia.
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Wang BH, Xie LT, Zhao QY, Ying HJ, Jiang TA. Balloon dilator controls massive bleeding during endoscopic ultrasound-guided drainage for pancreatic pseudocyst: A case report and review of literature. World J Clin Cases 2018; 6:459-465. [PMID: 30294611 PMCID: PMC6163145 DOI: 10.12998/wjcc.v6.i11.459] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/16/2018] [Accepted: 06/27/2018] [Indexed: 02/05/2023] Open
Abstract
Pancreatic pseudocyst (PPC), a common sequela of acute or chronic pancreatitis, was defined by the revised Atlanta classification as “a collection.” Endoscopic ultrasound (EUS)-guided drainage is often considered a standard first-line therapy for patients with symptomatic PPC. This effective approach exhibits 90%-100% technical success and 85%-98% clinical success. Bleeding is a deadly adverse event associated with EUS-guided drainage procedures, and the bleeding rate ranges from 3% to 14%. Hemostasis involves conservative treatment, endoscopy, interventional radiology-guided embolization and surgery. However, few studies have reported on EUS-guided drainage with massive, multiple hemorrhages related to severe pancreatogenic portal hypertension (PPH). Thus, the aim of this case report was to present a case using a balloon dilator to achieve successful hemostasis for PPH-related massive bleeding in EUS-guided drainage of PPC. To our knowledge, this method has not been previously reported.
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Affiliation(s)
- Bao-Hua Wang
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Li-Ting Xie
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Qi-Yu Zhao
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Hua-Jie Ying
- Department of Nurse, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Tian-An Jiang
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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Sandwell S, Montoya S, Towner JE, Markman JD, Schell MC, Bhalla T. Anatomical Study of Percutaneous Trigeminal Compressive Balloon Positioning on Merged 3-D Rotational X-Ray and Preprocedural Magnetic Resonance Imaging. Stereotact Funct Neurosurg 2018; 96:182-189. [PMID: 30032150 DOI: 10.1159/000489947] [Citation(s) in RCA: 1] [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: 11/28/2017] [Accepted: 05/10/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Percutaneous trigeminal rhizotomy or balloon compression for trigeminal neuralgia carries a potential risk for the brainstem, the carotid artery, and the basilar artery. OBJECTIVE To detail the relation of critical neural and vascular structures to expanded balloons used for percutaneous compression of the trigeminal ganglion. METHOD A retrospective analysis of preprocedural magnetic resonance imaging (MRI) and procedural X-ray-based imaging for 9 patients detailed balloon proximity to the brainstem, carotid artery, and basilar artery. RESULTS Balloons extended 10.96 ± 5.54 mm (mean ± SD) posterior to the clival line. The average distance from the balloon to the brainstem was 6.89 mm, and that to the basilar artery was 12.12 mm (range: 0-18.2). The medial edge of the balloon was an average distance of 1.39 mm from the baseline position of the carotid lumen. CONCLUSION Preprocedural MRI, merged with 3-D rotational angiography suite imaging, detailed the proximity of the balloon to critical neural and vascular structures. Our study found that the standard technique for percutaneous trigeminal compression, with balloon placement at an average depth of 10.96 mm posterior to the clival line, on average, provided an additional 6.89 mm of space before the brainstem would have been encountered, demonstrating safe positioning.
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Affiliation(s)
- Stephen Sandwell
- Department of Neurological Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Simone Montoya
- Department of Radiology, University of Rochester Medical Center, Rochester, New York, USA
| | - James E Towner
- Department of Neurological Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - John D Markman
- Department of Neurological Surgery, University of Rochester Medical Center, Rochester, New York, USA.,Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Michael C Schell
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York, USA
| | - Tarun Bhalla
- Department of Neurological Surgery, University of Rochester Medical Center, Rochester, New York, USA.,Department of Radiology, University of Rochester Medical Center, Rochester, New York, USA.,Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
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Wiggins A, Lonie M, Pimentil I, Newall N, Bodkin P, Venkatesh A. Electromagnetic neuronavigation for the percutaneous treatment of trigeminal neuralgia with balloon compression: technical note and cadaveric validation study. Acta Neurochir (Wien) 2018; 160:1337-41. [PMID: 29675717 DOI: 10.1007/s00701-018-3548-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/11/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Several techniques have been described for the percutaneous treatment of trigeminal neuralgia; however, each has significant drawbacks. We propose a new technique for percutaneous balloon compression of the trigeminal ganglion and distal trigeminal nerve using electromagnetic (EM) neuronavigation. METHODS The procedure was performed in 17 consecutive patients with trigeminal neuralgia. Patients were then followed up with telephone interview. We also performed a cadaveric validation study to further investigate the accuracy of the technique using dye. RESULTS Excellent clinical outcomes were achieved with a reduction in the median pain score from 10 out of 10 to 0 out of 10 following the procedure. The cadaveric study also demonstrated a high rate of foramen ovale cannulation. CONCLUSION EM-based targeting of the foramen ovale and balloon inflation within Meckel's cave is a quick, reproducible and straightforward technique for the percutaneous treatment of trigeminal neuralgia.
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Yang C, Wang G, Ma F, Yu B, Chen F, Yang J, Feng J, Wang Q. Repeated injections of human umbilical cord blood-derived mesenchymal stem cells significantly promotes functional recovery in rabbits with spinal cord injury of two noncontinuous segments. Stem Cell Res Ther 2018; 9:136. [PMID: 29751769 PMCID: PMC5948759 DOI: 10.1186/s13287-018-0879-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 01/24/2018] [Revised: 04/08/2018] [Accepted: 04/18/2018] [Indexed: 12/22/2022] Open
Abstract
Background Spinal cord injuries (SCIs) are sustained by an increasing number of patients each year worldwide. The treatment of SCIs has long been a hard nut to crack for doctors around the world. Mesenchymal stem cells (MSCs) have shown benefits for the repair of SCI and recovery of function. Our present study aims to investigate the effects of intravenously infused human umbilical cord blood-derived MSCs (hUCB-MSCs) on functional recovery after subacute spinal cord compression injury of two noncontinuous segments. In addition, we compared the effects of single infusion and repeated intravenous (i.v.) injections on the recovery of spinal cord function. Methods A total of 43 adult rabbits were randomly divided into four groups: control, single injection (SI), repeated injection at a 3-day (3RI) or repeated injection at a 7-day interval (7RI) groups. Non-immunosuppressed rabbits in the transplantation groups were infused with either a single complete dose or three divided doses of 2 × 106 hUCB-MSCs (3-day or 7-day intervals) on the first day post decompression. Behavioural scores and somatosensory evoked potentials (SEPs) were used to evaluate hindlimb functional recovery. The survival and differentiation of the transplanted human cells and the activation of the host glial and inflammatory reaction in the injured spinal cord were studied by immunohistochemical staining. Results Our results showed that hUCB-MSCs survived, proliferated, and primarily differentiated into oligodendrocytes in the injured area. Treatment with hUCB-MSCs reduced the extent of astrocytic activation, increased axonal preservation, potentially promoted axonal regeneration, decreased the number of Iba-1+ and TUNEL+ cells, increased the amplitude and decreased the onset latency of SEPs and significantly promoted functional improvement. However, these effects were more pronounced in the 3RI group compared with the SI and 7RI groups. Conclusions Our results suggest that treatment with i.v. injected hUCB-MSCs after subacute spinal cord compression injury of two noncontinuous segments can promote functional recovery through the differentiation of hUCB-MSCs into specific cell types and the enhancement of anti-inflammatory, anti-astrogliosis, anti-apoptotic and axonal preservation effects. Furthermore, the recovery was more pronounced in the rabbits repeatedly injected with cells at 3-day intervals. The results of this study may provide a novel and useful treatment strategy for the transplantation treatment of SCI. Electronic supplementary material The online version of this article (10.1186/s13287-018-0879-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chaohua Yang
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Jiangyang Area, Luzhou, 646000, Sichuan, China
| | - Gaoju Wang
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Jiangyang Area, Luzhou, 646000, Sichuan, China
| | - Fenfen Ma
- Department of Pharmacy, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, China
| | - Baoqing Yu
- Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong New Area, Shanghai, 201399, China
| | - Fancheng Chen
- Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong New Area, Shanghai, 201399, China
| | - Jin Yang
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Jiangyang Area, Luzhou, 646000, Sichuan, China
| | - Jianjun Feng
- Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong New Area, Shanghai, 201399, China.
| | - Qing Wang
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Jiangyang Area, Luzhou, 646000, Sichuan, China.
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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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Yang C, Yu B, Ma F, Lu H, Huang J, You Q, Yu B, Qiao J, Feng J. What is the optimal sequence of decompression for multilevel noncontinuous spinal cord compression injuries in rabbits? BMC Neurol 2017; 17:44. [PMID: 28231826 PMCID: PMC5324218 DOI: 10.1186/s12883-017-0824-3] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 02/16/2017] [Indexed: 11/20/2022] Open
Abstract
Background In recent years, multilevel spinal cord injuries (SCIs) have gained a substantial amount of attention from clinicians and researchers. Multilevel noncontinuous SCI patients cannot undergo the multiple steps of a one-stage operation because of a poor general condition or a lack of proper surgical approaches. The surgeon subsequently faces the decision of whether to initially relieve the rostral or caudal compression. In this study, we established a spinal cord compression model involving two noncontinuous segments in rabbits to evaluate the effects of differences in decompression order on the functional recovery of the spinal cord. Methods A Fogarty catheter was inserted into the epidural space through a hole in T6-7 and advanced 3 cm rostrally or caudally. Following successful model establishment, which was demonstrated by an evaluation of evoked potentials, balloons of different volumes (40 μl or 50 μl) were inflated in the experimental groups, whereas no balloons were inflated in the control group. The experimental groups underwent the first decompression in the rostral or caudal area at 1 week post-injury; the second decompression was performed at 2 weeks post-injury. For 6 weeks post-injury, the animals were tested to determine behavioral scores, somatosensory evoked potentials (SEPs) and radiographic imaging changes; histological and apoptosis assay results were subsequently analyzed. Results The behavioral test results and onset latency of the SEPs indicated that there were significant differences between priority rostral decompression (PRD) and priority caudal decompression (PCD) in the 50-μl compression group at 6 weeks post-injury; however, there were no significant differences between the two procedures in the 40-μl group at the same time point. Moreover, there were no significant peak-to-peak amplitude differences between the two procedures in the 50-μl compression group. Conclusions The findings of this study suggested that preferential rostral decompression was more beneficial than priority caudal decompression with respect to facilitating spinal cord functional recovery in rabbits with severe paraplegia and may provide clinicians with a reference for the clinical treatment of multiple-segment spinal cord compression injuries.
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Affiliation(s)
- Chaohua Yang
- Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Baoqing Yu
- Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Fenfen Ma
- Department of Pharmacy, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, China
| | - Huiping Lu
- Department of Pharmacy, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, China
| | - Jianmin Huang
- Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Qinghua You
- Department of Pathology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Bin Yu
- Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Jianlan Qiao
- Department of Radiology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Jianjun Feng
- Department of Orthopaedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China.
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Abstract
Trigeminal neuralgia (TN) is a neurologic disorder, defined by paroxysmal electric shocklike painful attacks in 1 or more trigeminal nerve branches. Treatment of TN is diverse and includes minimally invasive percutaneous techniques, which consist of balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation. Although all 3 techniques are generally safe, efficient, and effective, a clear consensus has not been reached regarding their specific indications and degree of efficacy. The aim of this article is to describe the percutaneous treatments available for TN and outline their characteristics, technique, indications and efficacy.
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Affiliation(s)
- Symeon Missios
- Department of Neurosurgery, Neurological Institute, The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, 9500 Euclid Avenue, S73, Cleveland, OH 44195, USA
| | - Alireza M Mohammadi
- Department of Neurosurgery, Neurological Institute, The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, 9500 Euclid Avenue, S73, Cleveland, OH 44195, USA
| | - Gene H Barnett
- Department of Neurosurgery, Neurological Institute, The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, 9500 Euclid Avenue, S73, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, NA21, Cleveland, OH 44195.
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Abdennebi B, Guenane L. Technical considerations and outcome assessment in retrogasserian balloon compression for treatment of trigeminal neuralgia. Series of 901 patients. Surg Neurol Int 2014; 5:118. [PMID: 25101213 PMCID: PMC4123256 DOI: 10.4103/2152-7806.137838] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 11/13/2013] [Accepted: 04/24/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The aim of our study was to describe the retrogasserian balloon compression (RGBC) procedure with some personal tricks and to assess the long-term results. METHODS Between 1985 and 2012, 901 patients, suffering from refractory trigeminal neuralgia (TN), underwent RGBC procedure in our department. Concerning the surgical technique, the introducer was in close contact with the posterior extremity of the horizontal plate of the palatine bone and had the direction of the bisector of the angle clivus-superior edge of the petrous bone on an X-rays sagittal view. No metallic material was inserted intracranially. The balloon was inflated with 0.7 cc of contrast medium for 6 min. RESULTS At 1 month follow up, appreciable pain relief was obtained in 835 patients (92.7%). At 1 year, results were excellent in 605 patients (67.1%), satisfactory in 109 patients (12.1%), poor in 57 patients (6.3%), fair in 66 patients (7.3%), whereas recurrences were observed in the remaining 64 patients (7.2%). At mean follow up of 16,5 years, 559 (62%) patients remained pain free. Twenty six patients (2,8%) continued to experience severe pain. Recurrences occurred in two hundred and fifty patients (27,8%). Fifty two of them were operated on a third time and 22 underwent four procedures. CONCLUSION RGBC IS AN APPROPRIATE AND EFFECTIVE PROCEDURE FOR TREATMENT OF REFRACTORY TN, ENSURING A LONG LASTING PAIN RELIEF PREDICTED ON THREE FACTORS: pear shape of the balloon, its volume, and duration as mentioned earlier.
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Affiliation(s)
- Benaissa Abdennebi
- Department of Neurosurgery, Salim Zemirli Hospital - University of Algiers, Algiers, Algeria
| | - Lakhdar Guenane
- Department of Neurosurgery, Salim Zemirli Hospital - University of Algiers, Algiers, Algeria
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24
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Cao P, Zheng Y, Zheng T, Sun C, Lu J, Rickett T, Shi R. A model of acute compressive spinal cord injury with a minimally invasive balloon in goats. J Neurol Sci 2013; 337:97-103. [PMID: 24332594 DOI: 10.1016/j.jns.2013.11.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 07/15/2013] [Revised: 11/15/2013] [Accepted: 11/17/2013] [Indexed: 10/26/2022]
Abstract
Research into spinal cord injury depends upon animal models of trauma. While investigations using small animals have yielded critical insights into the cellular mechanisms of neurotrauma, no effective therapies have been translated to human clinical treatments. There are considerable differences in pathophysiology, scale, and anatomical organization between rodents and primates. Here, the established method of inflating balloons to compress the cord within the spinal canal was adapted for use in goats. By using surgical techniques to insert a kyphoplasty balloon, spinal cord injury was accomplished with minimal trauma to the surrounding tissues, as is common in other traumatic models. Dye volumes of 0, 1.26 ± 0.18, and 2.82 ± 0.20 mL were injected into the balloon to produce spinal occupancies of 0%, 33 ± 2%, and 89 ± 4%, as evaluated by X-ray and computerized tomography imaging. A significant dose response was observed for the different levels of trauma, with reduced conduction of somatosensory evoked potentials and impaired mobility 7 days after injury. From the strong correlations between injection volume, balloon pressure, spinal occupancy, nerve function, and animal behavior, we conclude that hydraulic compression in goats is a useful model of spinal cord injury.
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Affiliation(s)
- Peng Cao
- Department of Orthopedics, Rui-Jin Hospital, School of Medicine, Shanghai Jiao-tong University, Institute of Trauma and Orthopedics, Shanghai 200025, China
| | - Yuhuang Zheng
- Department of Orthopedics, Rui-Jin Hospital, School of Medicine, Shanghai Jiao-tong University, Institute of Trauma and Orthopedics, Shanghai 200025, China
| | - Tao Zheng
- Department of Orthopedics, Rui-Jin Hospital, School of Medicine, Shanghai Jiao-tong University, Institute of Trauma and Orthopedics, Shanghai 200025, China
| | - Changwei Sun
- Department of Orthopedics, Rui-Jin Luwuan Hospita, School of Medicine, Shanghai Jiao-tong University, Shanghai 200025, China
| | - Jiong Lu
- Department of Orthopedics, Rui-Jin Luwuan Hospita, School of Medicine, Shanghai Jiao-tong University, Shanghai 200025, China
| | - Todd Rickett
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Riyi Shi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA; Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA.
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