ABSTRACT
Objective To evaluate the efficacy of radiofrequency thermocoagulation guided by three-dimensional computer tomography(3-D CT)for the treatment of severe recurrent glossopharyngeal neuralgia(GPN). Methods Twenty-nine patients of both sexes with recurrent intractable GPN, aged 42-75 yr, with recurrent course of 1-8 yr, of Barrow Neurological Institute(BNI)Pain Scale(BNI-P) class Ⅳ or Ⅴ, were enrolled in this study. Percutaneous radiofrequency thermocoagulation was applied to the middle and lower segment of the styloid process of the glossopharyngeal nerve under 3D CT guidance. Before operation and at 72 h, 6 months and 1 year after operation, BNI-P class and BNI Numbness Scale scores were recorded, and effective treatment and operation-related complications were also recorded. Re-sults Nineteen patients underwent one operation, 8 patients underwent two operations, and 2 patients un-derwent three operations. BNI-P class was significantly lower at each time point after operation than before operation(P<0.05). The rate of effective treatment was 100% at 72 h and 6 months after operation and 97% at 1 yr after operation. Different degrees of dysesthesias at the posterior part of the tongue on the affect-ed side occurred after operation and disappeared at 1 yr after operation. Operation-related nausea and vomi-ting, facial nerve damage, accessory nerve damage and fatality were not observed. Conclusion 3D CT-guided radiofrequency thermocoagulation of the glossopharyngeal nerve provides reliable efficacy and higher safety for the patients with severe recurrent GPN.
ABSTRACT
ObjectiveTo evaluate the efficacy of epidural infusion of a mixture of bupivacaine-fentanyl-dexamethasone on top of intravenous extract from rabbit skin inflamed by vaccinia virus (ERSVV) for severe herpetic neuralgia.MethodsForty-eight patients of both sexes with severe herpetic neuralgia aged 45-92 yr were randomly divided into 2 groups (n =24 each):control group (group C) and test group( group T).Both groups received intravenous ERSVV 6 ml/d.Group C received oral amitriptyline and gabapentin,while the group T received epidural infusion of 100 ml of a mixture of 0.075％ bupivacaine,fentanyl 2 μg/ml and dexamethasone 50 μg/ml in normal saline at 2-5 ml/h,once a day for 10 days and VAS score was maintained≤4.Epidural puncture was performed at the spinal segments severely affected by herpes virus.Intensity of pain was assessed with VAS (0 =no pain,10 =worst pain).In group C when VAS ＞ 4 oral amitriptyline 12.5 mg (once/d) and gabapenti 0.1 g (3 times/d) were given as rescue analgesics.Adverse effects of epidural infusion and incidence of post-herpetic neuralgia were recorded.ResultsThe incidence of urinary retention and incidence of post-herpetic neuralgia were lower in group T than in group C.No other adverse effects were found in group T.ConclusionEpidural infusion of a mixture of bupivacaine-fentanyl-dexamethasone on top of ERSVV can effectively reduce severe herpetic neuralgia and prevent development of post-herpetic neuralgia safely.