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Objective:To explore the measures for prevention of pneumothorax in CT-guided thoracic sympathetic block.Methods:The clinical data of 769 patients with hyperhidrosis or Raynaud syndrome treated with CT-guided chemical destructive block of thoracic sympathetic nerve chain in Jiaxing First Hospital from January 2010 to December 2017 were retrospective analyzed. The CT-guided thoracic sympathetic nerve block puncture was performed with a special blunt needle outside the wall pleura above the caput costae following the principle of "safe distance" and "advance only". After exclusion of pneumothorax by CT scan, 2.5 ml of absolute ethanol mixed with 30% iohexol 0.25 ml was injected on both sides of thoracic sympathetic nerve chain.Results:The punctures were successfully performed in all 769 patients (1 538 nerve chain segments) and no pneumothorax occurred. After treatment with absolute ethanol injection, Horner syndrome occurred in 31 patients, which disappeared after injecting saline into the stellate ganglion; and intercostal neuralgia occurred in 188 patients after surgery, which was healed in 1 to 3 months.Conclusion:It is suggested that pneumothorax can be avoided through CT guidance, using appropriate needles and puncture techniques during the procedure of thoracic sympathetic nerve chain block.
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Objective To observe the clinical effect of CT-guided percutaneous puncture of stylomastoid foramen and radiofrequency ablation on primary hemifacial spasm. Methods Twenty-seven patients with primary hemifacial spasm, admitted to and accepted CT-guided percutaneous puncture of stylomastoid foramen and radiofrequency ablation in our hospital from August 2018 to May 2019, were chosen in our study. Clinical data and efficacy of the patients were retrospectively analyzed. Results All patients were punctured to the stylomastoid foramen precisely under the guidance of CT localization; 21 could detect facial muscle twitch with 0.1-0.5 mA current, and positive results were also found in 6 patients with 0.5 mA current after adjusting the position of the needle tip. After standard radio frequency ablation (mean 83.3 ℃ for 23.7 seconds), 26 patients had complete disappearance of facial spasm, but left grade II (n=18) or grade III (n=8) facial paralysis; one patient with disappearance of abnormal electromyographic response waveform as the end criterion only partially relieved, but no facial paralysis. No facial hematoma, intracranial hemorrhage, infection, or death occurred. Follow-up for 2-12 months showed no recurrence or aggravation of facial paralysis. Conclusion CT-guided percutaneous puncture of stylomastoid foramen by radio frequency ablation can effectively treat primary hemifacial spasm, but there will be mild facial paralysis.
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Objective To compare the efficacy of CT-guided radiofrequency thermocoagulation (RFTC) treatment through the inside and outside of the foramen rotundum for primary trigeminal maxillary neuralgia.Methods Forty-eight patients of both sexes,aged 58-75 yr,suffering from primary trigeminal neuralgia the 2nd trigeminal branch pain,scheduled for elective CT-guided trigeminal RFTC,were divided into 2 groups (n =24 each) using a random number table:inside of foramen rotundum group and outside of foramen rotundum group.The needle was inserted until the lateral 1/3 of the foramen rotundum was reached under CT guidance in inside of foramen rotundum group or until the outside of the foramen rotundum was reached in outside of foramen rotundum group.High-temperature RFTC 95 ℃ was performed for 120 s,repeating for 2-3 cycles.The current sensory threshold at different frequencies was measured at 1 day before and after operation.Numeric rating scale score was performed at 1 day,30 days,1 yr and 2 yr after operation,effective RFTC treatment was defined as numeric rating scale score≤ 1,and the condition of postoperative effective RFTC treatment was recorded.The development of adverse reactions such as facial hematoma,corneal ulcer,injuring the other branch and cerebrovascular accidents was recorded.Results Compared with outside of foramen rotundum group,the current sensory threshold on the affected side at frequency of 2 000 Hz was significantly increased at 1 day after operation,the rate of effective RFTC treatment was increased 2 yr after operation (P＜0.05),and no significant change was found in the incidence of postoperative facial hematoma in inside of foramen rotundum group (P＞0.05).Conclusion The long-term curative effect of CT-guided RFTC treatment for primary trigeminal maxillary neuralgia through the inside of the foramen rotundum is better than that through the outside of foramen rotundum.
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Objective To evaluate the efficacy of chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequency in treating upper limb postherpetic neuralgia ( PHN). Methods Forty-two patients of both sexes with upper limb PHN, aged 48-75 yr, were divided into 2 groups ( n=21 each) using a random number table method: chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequency group ( TSNM+PR group) and pulsed radiofrequency group ( PR group) . TSNM+PR group was treated using chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequen-cy, and PR group received pulsed radiofrequency alone. The occurrence of treatment-related adverse reac-tions was recorded. Numeric rating scale scores were recorded preoperatively and at 1 day and 1 and 3 months after operation, and the efficacy was graded. The effective treatment and pain recurrence were re-corded 3 months after operation. Quantitative sensory nerve tests were performed to record the current per-ception threshold before operation and on 1 day, 1 month and 3 months after operation. Results Compared with PR group, numeric rating scale score was significantly decreased, the therapeutic effect was en-hanced, the rate of effective treatment was increased, the recurrence rate of pain was decreased at 1 and 3 months after surgery, the current perception threshold at 250 and 5 Hz on the ipsilateral side was increased at 1 and 3 months after surgery in TSNM+PR group ( P<0. 05) . No treatment-related adverse reactions were found in two groups. Conclusion Chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequency provides reliable therapeutic effect and higher safety for upper limb PHN.