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Objective @#To investigate the clinical efficacy and application value of an improved 3D-printed guide plate for the treatment of primary trigeminal neuralgia (PTN) by percutaneous microballoon compression (PMC). @*Methods @# This prospective study included 42 patients with primary trigeminal neuralgia treated at the Department of Stomatology, Xuzhou Central Hospital, from September 2019 to January 2022. The group was divided by the random number table method into the experimental group (adopting 3D printing technology to make guide plates to guide the puncture, 22 cases) and the control group (adopting the traditional Hartel anterior approach to position the puncture, 20 cases). The intraoperative success rate of the first puncture, puncture time, operative time, radiation exposure of patients and postoperative complications were compared between the two groups. Postoperative Barrow Neurological Institute Scale (BNI) scores, facial numbness, diminished corneal reflexes and chewing weakness were recorded. The t-test, rank-sum test and chi-square test were used for statistical analysis, with P<0.05 indicating a statistically significant difference. @*Results @#The experimental group was significantly better than the control group in terms of the success rate of the first puncture (χ2 = 21.51, P<0.001), puncture time (Z = -5.51, P<0.001), operative time (t = 9.37, P<0.001), and the number of C-arm scans (Z = -4.59, P<0.001). Postoperative BNI scores of the experimental group included 21 cases of grade Ⅰ (91.5%) and 1 case of grade Ⅱ, while the control group included 17 cases of grade Ⅰ (85.0%), 2 cases of grade Ⅱ (10.0%) and 1 case of grade Ⅲ (5.0%), with no statistical significance (P>0.05). In the experimental group, 16 patients had postoperative masseter weakness, 1 had keratitis and 10 had perilabial herpes, while in the control group, 18 patients had postoperative masseter weakness, 2 had keratitis, 11 had perilabial herpes and 1 had monocular blindness. There was no significant difference in postoperative complications between the two groups (P>0.05). At 12 months of follow-up, there was no recurrence in either the experimental or control group. @* Conclusions @#3D digital guide plate-guided percutaneous microballoon compression for primary trigeminal neuralgia can improve the accuracy and safety of puncture to a certain extent, obviously shorten the operation time, reduce radiation exposure of the patients, improve the success rate of the operation, meaning it has a high clinical application value.
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OBJECTIVES@#Primary trigeminal neuralgia (PTN) is a common cranial nerve disease in neurosurgery, which seriously endangers the physical and mental health of patients. Percutaneous balloon compression (PBC) has become an effective procedure for the treatment of PTN by blocking pain conduction through minimally invasive puncture. However, the recurrence of facial pain after PBC is still a major problem for PTN patients. Intraoperative balloon shape, pressure and compression time can affect the prognosis of patients with PBC after surgery. The foramen ovale size has an effect on the balloon pressure in Meckel's lumen. This study aims to analyse the predictive value of foramen ovale size for postoperative pain recurrence of PBC by exploring the relationship between foramen ovale size and postoperative pain recurrence of PBC.@*METHODS@#A retrospectively analysis was conducted on the clinical data of 60 patients with PTN who were treated with PBC in Department of Neurosurgery, Affiliated Hospital of Chengde Medical College from November 2018 to December 2021. We followed-up and recorded the Barrow Neurological Institute (BNI) pain score at 1, 3, 6 and 12 months after operation. According to the BNI pain score at 12 months after surgery, the patients were divided into a cure group (BNI pain score I to Ⅱ) and a recurrence group (BNI pain score Ⅲ to Ⅴ). The long diameter, transverse diameter and area of foramen ovale on the affected side and the healthy side of the 2 groups were measured. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used for analysis the relationship between the recurrence of pain and the long diameter, transverse diameter, area of foramen ovale on the affected side, and aspect ratio, transverse diameter ratio, area ratio of foramen ovale on the affected side to healthy side in the 2 groups.@*RESULTS@#At the end of 12 months of follow-up, 50 (83.3%) patients had pain relief (the cured group), 10 (16.7%) patients had different degrees of pain recurrence (the recurrence group), and the total effective rate was 83.3%. There were no significant differences in preoperative baseline data between the 2 groups (all P>0.05). The long diameter of foramen ovale on the affected side, the long diameter ratio and area ratio of foramen ovale on the affected/healthy side in the cured group were significantly higher than those in the recurrence group (all P<0.05), and there were no significant differences in the transverse diameter and area of foramen ovale on the affected side and the transverse diameter ratio of foramen ovale on the affected/healthy side between the 2 groups (all P>0.05). The ROC curve analysis showed that the AUC of the long diameter of foramen ovale on the affected side was 0.290 (95% CI 0.131 to 0.449, P=0.073), and the AUC of aspect ratio of foramen ovale on the affected side to healthy side was 0.792 (95% CI 0.628 to 0.956, P=0.004). The AUC of area ratio of foramen ovale on the affected side to healthy side was 0.766 (95% CI 0.591 to 0.941, P=0.008), indicating that aspect ratio and area ratio of foramen ovale on the affected side to healthy side had a good predictive effect on postoperative pain recurrence of PBC. When aspect ratio of foramen ovale on the affected side to healthy side was less than 0.886 3 or area ratio of foramen ovale on the affected side to healthy side was less than 0.869 4, postoperative pain recurrence was common.@*CONCLUSIONS@#Accurate evaluation of the foramen ovale size of skull base before operation is of great significance in predicting pain recurrence after PBC.
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Humans , Retrospective Studies , Foramen Ovale , Treatment Outcome , Trigeminal Neuralgia/surgery , Pain, Postoperative/etiology , RecurrenceABSTRACT
Objective To investigate the treatment measures of having trigeminocardiac reflex (TCR) for the primary trigeminal neuralgia via microvascular decompression.Methods From January 2016 to December 2016,the clinical data and anesthesia records of 79 consecutive patients with primary trigeminal neuralgia admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University and treated the first craniotomy microvascular decompression were analyzed retrospectively.They were divided into a no TCR group (n=63) and a TCR group (n=16) according to the intraoperative anesthesia monitoring.The differences of baseline conditions,preoperative complications and pain involved the trigeminal nerve branches were compared between the two groups.The treatment measures and short-term prognosis of the patients with TCR during operation were summarized.Results (1) The proportion of hypertension in the TCR group was 31.2％ (n=5),it was higher than 7.9％ in the no TCR group (n=5).There was significant difference (χ2=6.273,P<0.05).(2) During the operation of microvascular decompression,16 patients in the TCR group had 19-time TCR.The baseline heart rate was 74±10/min before operation,and the heart rate decreased to 51±6/min at onset of TCR.The mean baseline arterial blood pressure was 102±13 mmHg,and the mean arterial blood pressure decreased to 74±8 mmHg at the onset of TCR.There was significant difference (P<0.05).(3) After the onset of TCR,the operation of was stopped,heart rate and the blood pressure recovered spontaneously (n=4).Fifteen patients were treated with medications,including using atropine (12 times,dose 0.2-0.5 mg) and ephedrine hydrochloride (3 times,dose 5-10 mg).Heart rate and blood pressure returned to the baseline level within 20 seconds or 20 seconds after administration of medications.There was no TCR-related cardiac complication or neurological deficit from after procedure to before discharge.Conclusions In microvascular decompression of primary trigeminal neuralgia,if TCR occurs,the selective use of anticholinergic agents or vasoactive agents is needed as early as possible.The risk factors for the occurrence of TCR need to be further verified.
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Objective To summarize the microvascular decompression(MVD)surgery of vertebrobasilar blood vessel for primary trigeminal neuralgia patients. Methods Clinical data of 28 primary trigeminal neuralgia patients caused by vertebrobasilar blood vessel from October 2008 to June 2016 in our hospital were retrospectively analyzed.There were 25 patients receving MVD and 3 patients receiving MVD and trigeminal sensory-root partial rhizotomy. Results The neuralgia in all the 28 patients immediately disappeared after surgery.Facial hypesthesia on the operation side occurred in 3 patients receiving MVD and trigeminal sensory-root partial rhizotomy.During follow-ups for 3 -24 months(mean, 18.6 months), none of the trigeminal neuralgia relapsed. Conclusions For primary trigeminal neuralgia patients caused by vertebrobasilar blood vessel, adequate nerve decompression and restoration of normal nerve anatomy are the guarantee for the efficacy of MVD surgery.For vessels with tensions and can not be passaged by one-time,multi-point decompression can complete the surgery.
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Objective To summarize the microvascular decompression(MVD)surgery of vertebrobasilar blood vessel for primary trigeminal neuralgia patients. Methods Clinical data of 28 primary trigeminal neuralgia patients caused by vertebrobasilar blood vessel from October 2008 to June 2016 in our hospital were retrospectively analyzed.There were 25 patients receving MVD and 3 patients receiving MVD and trigeminal sensory-root partial rhizotomy. Results The neuralgia in all the 28 patients immediately disappeared after surgery.Facial hypesthesia on the operation side occurred in 3 patients receiving MVD and trigeminal sensory-root partial rhizotomy.During follow-ups for 3 -24 months(mean, 18.6 months), none of the trigeminal neuralgia relapsed. Conclusions For primary trigeminal neuralgia patients caused by vertebrobasilar blood vessel, adequate nerve decompression and restoration of normal nerve anatomy are the guarantee for the efficacy of MVD surgery.For vessels with tensions and can not be passaged by one-time,multi-point decompression can complete the surgery.
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Objective To compare the clinical efficacy of gabapentin and carbamazepine in the treatment of elderly patients with primary trigeminal neuralgia.Methods 96 cases of elderly patients with primary trigeminal from March 2014 to March 2016 were selected and randomly divided into gabapentin group and carbamazepine group, which each group with 48 cases.The clinical efficacy, adverse reactions and changes of pain, insomnia, anxiety, depression status and oxidative stress indexes were compared.Results After treatment, there was no significant difference in total effective rate between two groups.And the excellence rates in gabapentin group was 60.4%, which significantly higher than that in carbamazepine group with 37.5%, the difference was statistically significant ( P <0.05 ) .After treatment, VAS score and sleep disturbance score in gabapentin group were significantly lower than those in carbamazepine group, the difference was statistically significant (P<0.05), and SAS score and SDS score were also significantly lower than those in carbamazepine group, the difference was statistically significant (P<0.05).The adverse reactions rates in gabapentin group was 22.9%, which significantly higher than that in carbamazepine group with 43.8%, the difference was statistically significant ( P <0.05 ) . Conclusion Compared with carbamazepine, gabapentin in the treatment of elderly patients with primary trigeminal neuralgia can enhance clinical effect , improve pain, insomnia, anxiety, depression status.
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Objective To detect the therapeutic effectiveness of electro-acupuncture combined with Leitoufenggranules for primary trigeminal neuralgia.MethodsA total of 60 patients with PTN were randomly divided into the control group and the treatment group (30 in each group). Control group received Carbamazepine, and the treatment group received the electro-acupuncture combined withLeitoufeng granules. Both groups were treated for 15 days as a period of treatment with 3 treatments in total. The outcomes were S hort form of the McGill Pain Questionnaire (SF-MPQ), painratingindex (PRI), the number of word feature (NWC), the present painindex (PPI), the Visual Analogue Scale (VAS) the clinical effect rate and recurrence rate. Results After treatment, compared with the control group, the effect rate (96.67%vs. 70.00%,χ2=5.880,) in the treatment group showed significantly higher (P=0.015). Compared with the control group, PRI (0.20 ± 0.47 vs. 3.33 ± 4.65,t=3.592), NWC (0.20 ± 0.48vs. 1.40 ± 1.87,t=3.345), VAS (0.20 ± 0.48vs. 1.27 ± 1.66, t=3.321), PPI (0.17 ± 0.38vs.0.90 ± 0.99,t=3.771) and the total score (0.79 ± 1.83vs. 6.90 ± 9.05,t=3.602) in the treatment group were significantly lower (P<0.01). In the follow-up of 3 months, compared with control group, the recurrence rate (10.0%vs.56.6%,χ2=12.675) in the treatment group significantly lower (P<0.01). Conclusion As to the treatment of primary trigeminal neuralgia, the effect of acupuncture combined with Leitoufeng granules was superior to the Carbamazepine.
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Objective Toexplore the application value of diffusion tensor imaging (DTI) in evaluating evaluation offunctional changes of the in patients with primary trigeminal neuralgia caused (PTN) by neurovascular compression. Methods 40 unilateral PTN patients and 40 healthy volunteers were enrolled in ourstudy.They allAll patients underwent the general sequences and DTI ,and then to measured the ADC and FA values of the trigeminal nerves. Results (1) Compared with contralateral side (0.408 ± 0.054)and bilateral sides in control group(0.423 ± 0.057), FA value of the ipsilateral side in PTN group(0.330 ± 0.056) was significant lower (P< 0.05)compared with the contralateral side (0.408 ± 0.054) and bilateral sides in control group (0.423 ± 0.057).The ADC value of ipsilateralside (2.052 ± 0.473)× 10-3 mm2/s was significantly higher (P < 0.05) thancompared withthe contralateral side (1.541 ± 0.266) ×10-3 mm2/s and bilateral sides in control group(1.431 ± 0.308) ×10-3 mm2/s. (2) An There's a nnegative correlation was found (r = -0.613,P < 0.001) between the loss of FA and the increase of ADC (r = -0.613,P < 0.001). Conclusion DTI could be used to evaluate the changes of neuratrophy and demyelination ,so it canmight be used of in diagnosis and treatment of PTNin further way.
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Objective To investigate the alterations of interhemispheric resting-state functional connectivity in patients with chro-nic primary trigeminal neuralgia (CPTN).Methods Twenty patients with CPTN and 20 age-,gender-,and education-matched healthy subjects underwent a resting-state functional magnetic resonance imaging (rs-fMRI)scanning.The voxel-mirrored homo-topic connectivity(VMHC)approach and statistic analysis were used to investigate the interhemispheric coordination of the whole brain.Results Compared with healthy controls,decreased VMHC was found in patients with CPTN,including medial and lateral or-bitofrontal cortex,and premotor (P <0.05,GRF corrected).Conclusion Our results suggest that decreased VMHC in brain regions indicate the aberrant perceptual and affective processing of CPTN,and limited complex movements function.
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Objective To evaluate the relationship between preoperative MRI characteristics and the perioperative outcomes of microvascular decompression in primary trigeminal neuralgia. Methods To analyze the relationship between preoperative MRI characteristics and the perioperative outcomes in 103 primary trigeminal neuralgia patients with micro-vascular decompression in Nanfang Hospital. The MRI features such as the ratio of CPA area, TGN cross-sectional area and TGN length was evaluated together with the TGN oppression distance, the position of TGN, the position of basilar ar-tery and the type of offending vessel as well as the outocmes including complete disappearance, temporary remission and ineffectiveness. Results Univariate analysis showed that the oppression orientation (P=0.017), oppression distance (P<0.001), offending vascular type (P=0.016), TGN cross-sectional area ratio (P<0.001) were the influencing factors of periop-erative outcomes. Logistic regression analysis showed that the offending vascular type (P=0.002)and TGN cross-sectional area ratio (P=0.020) were the main predictive factors of perioperative outcomes of microvascular decompression. Conclu-sions Preoperative thin slice MRI scanning showed that the offending artery, non-atrophy nerve roots, far distance from op-pression point to brainstem may be the favorable factors of perioperative outcomes of microvascular decompression.
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@#ObjectiveTo observe the effect of Integrated Traditional Chinese and Western Medicine on primary trigeminal neuralgia. Methods126 cases with primary trigeminal neuralgia were divided into treatment group (63 cases) and control group (63 cases), who accepted Integrated Traditional Chinese and Western Medicine and western medicine only. They were assessed with Chinese version McGill Pain Questionnaire before and after treatment, and followed up for 1 year. ResultsThe incidence of cure in treatment group was higher than that of control group (P<0.05), and the relapse was reduced (P<0.05). ConclusionThe Integrated Traditional and Western Medicine is more effective on primary trigeminal neuralgia, and reduce the relapse.
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Objective To evaluate the therapeutic efficacy of gamma knife in treatment of primary trigeminal neuralgia Methods Retrospectively analysis of 120 cases with primary trigeminal neuralgia treated by gamma knife in our department From Jan. 2003 to Mar. 2008 were performed. All cases were treated with the 4 mm collimator and targeted at the proximal nerve at the root entry zone located by MRI. The target dose varied from 80 -90 Gy. Results After a follow-up of 20. 0 ±4. 5 months, complete relief of pain occurred in 69 patients (57. 5%), 50% -90% relief in 34 (28. 3%), relief less than 50% in 12(10.0%) but no relief in 5(4.2 %).The efficient rate was 95. 8% . The common complications include numbness, absence of corneal reflex. 83 patients (69. 2%) experienced temporal facial numbness and 14 patients (11. 7%) reported continuous numbness after treatment of the gamma knife. Conclusions Gamma knife radiosurgery is a minimally invasive technique for the treatment of primary trigeminal neuralgia with few complications.
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In 48 postoperative cases using ear-clinoidal line positioning in radiofrequency thermocoagulation for treatment of trigeminal neuralgia,observing its recurrence and postoperative pain and complications in a five-year review. The successful rate of puncturing one time was 100%. Pain disappeared completely in 46 cases with one therapy. Two cases alleviated pain and decreased outbreak times. No recurrence and postoperative complications were observed. The vertical distance between the needle tip and the ear-clinoidal line were confirmed 8-10 mm in the third branch, 6-7 mm in the twice branch, 4-5 mm in the first branch. In order to avoid the first branch of trigeminal nerve injury, the vertical distance must be less than 6 mm, and the needle tip can not exceed ear-clinoidal line.
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Objective:To observe the clinical efficacy and safety of radiofrequency thermocoagulation on the treatment of primary trigeminal neuralgia guided with digital substraction angiography(DSA) in short-term,mid-term prospect.Methods:Twenty-seven patients of PTN were positioned by DSA,then treated with radiofrequency thermocoagulation.The VAS scores,clinical efficacy and complication were observed nearly post-treatment.The effects in mid-term was assessed in secondary follow-up.Results:All patients were punctured successfully.After treatment,all patients have pain relief.VAS scores on day 1,day 3,week 1 after radiofrequency thermocoagulation were 2.12?0.64,1.04?1.02,0.46?0.31 respectively,decreased compared with that before treatment(P