Radiofrequency thermoablation of the peripheral branches of trigeminal nerve versus the Gasserian ganglion for treating idiopathic trigeminal neuralgia: A systematic review and meta-analysis.

BACKGROUND: Trigeminal neuralgia is characterized by pain at the distribution of one or more of the trigeminal nerve branches and is usually treated with anti-epileptic medication. When first line treatment fails, patients receive other treatment modalities including radiofrequency thermoablation (RFT) of the Gasserian ganglion and peripheral branches of the trigeminal nerve. The aim of this study is to compare RFT of the Gasserian ganglion and peripheral branches of trigeminal nerve in terms of efficacy and rate of complications. METHODS: This was a systematic review and meta-analysis that searched Medline, Cochrane Central Register of Controlled Trials, and Embase using Medical Subject Headings and the references of the enrolled studies with no restriction on date. We included only RCTs that compared the RFT of the Gasserian ganglion and peripheral branches of trigeminal nerve with one of the following outcomes: pain scales, immediate effective rate, recurrence rate, and complications. RESULTS: Five articles were eligible for our review and showed that there was no difference between RFT of the peripheral nerves and the Gasserian ganglion in terms of pain scores. There was a non-significant trend for RFT of the peripheral nerve to have higher immediate effect rates and higher recurrence rates. RFT of the Gasserian ganglion group was associated with masticatory weakness, while the other group was associated with facial swelling and numbness of V2. CONCLUSION: RFT of the peripheral branches is a safe and effective method to treat idiopathic trigeminal neuralgia but leads to a higher recurrence rate when compared with RFT of the Gasserian ganglion.

Influence of aspirin on prevention of colorectal cancer: an updated systematic review and meta-analysis of randomized controlled trials.

PURPOSE: Colorectal cancer is the second most common cause of cancer death worldwide. Aspirin, due to its antineoplastic effects, has been suggested to have chemopreventive effects on colorectal cancer based on recent trials. We conducted this systematic review and meta-analysis to provide an updated evidence about the long-term efficacy of daily aspirin use in the prevention of colorectal cancer. METHODS: We searched Medline/PubMed, Ovid, Web of Science, and Cochrane Library. We included randomized controlled trials (RCTs) that compared the efficacy of daily aspirin use to placebo in healthy individuals at the time of study entry. The desired outcomes of this review were the incidence of advanced lesions (i.e., adenomas with villous component, adenomas ≥1 cm in diameter, adenomas with high-grade dysplasia, and/or invasive cancer) and colorectal adenomas. RESULTS: A total of 15 articles representing 11 RCTs were included. Overall, the results indicated that aspirin significantly reduced the risk of developing colorectal adenomas but not advanced lesions at 3 years (risk ratio (RR) = 0.84, P < 0.05 and risk ratio = 0.82, P = 0.10, respectively). At 5 years, the risk of advanced lesions but not adenomas was reduced by aspirin (RR = 0.68, P < 0.05 and RR = 0.87, P = 0.22, respectively). Aspirin was not found to have an effect on the risk of advanced lesions or adenomas beyond 5 years (hazard ratio (HR) = 0.82, P = 0.07 and HR = 0.99, P = 0.82, respectively). CONCLUSION: Overall, aspirin (particularly high dose) only reduced the risk of advanced lesions up to 5 years.