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Bing Huang - One of the best experts on this subject based on the ideXlab platform.

  • Personalized needle modification for CT-guided percutaneous infrazygomatic radiofrequency ablation of the maxillary nerve through the Foramen Rotundum in order to treat V2 trigeminal neuralgia.
    Journal of pain research, 2019
    Co-Authors: Bing Huang, Ming Yao, Keyue Xie, Qianying Liu, Yajing Chen, Yong Fei
    Abstract:

    Background: The computed tomography (CT)-guided radiofrequency ablation (RFA) of the maxillary nerve (V2) via Foramen Rotundum (FR) approach has been reported to offer the highest rates of pain relief in V2 trigeminal neuralgia (TN). However, the access to FR may be obstructed by the greater wing of the sphenoid bone. Objectives: We report on an optimized CT-guided percutaneous infrazygomatic of maxillary nerve through the Foramen Rotundum (FR) to treat V2 trigeminal neuralgia (TN) using personalized RFA needles based on patient’s individual CT-image parameters. Patients and methods: 176 patients with isolated V2 TN were included. If the entry of the percutaneous needle into the FR canal was blocked by the greater wing of the sphenoid bone, straight RFA needles was bent at the tip with an angle α (the angle between the straight line from the external opening of FR to the skin entry point and the long axis of the FR canal). The maxillary nerve RFA was performed after confirmation with electrophysiological tests. Pain relief in the V2 territory and TN recurrence rate were followed for up to 60 months. Results: Fifty-two patients (29.55%) required needle bending. The maxillary nerve thermal RFA resulted in analgesia in the V2 territory without affecting the V1 or V3 zone. TN recurrence rate at 6, 12, 24, 36, 48 and 60 months was 2.55%, 7.64%, 17.20%, 24.41%, 30.28% and 33.77%, respectively. Conclusion: The personalized needle modification technique for maxillary nerve RFA through FR is safe and effective to treat V2 TN.

  • The Value and Application of Personalized Needle Modification in Percutaneous Infrazygomatic Radiofrequency in Isolated Maxillary Nerve Pain through the Foramen Rotundum.
    Pain physician, 2019
    Co-Authors: Yajing Chen, Bing Huang, Qianying Liu, Qiang Zhu, Yibing Yao, Chunyan Zhu, Wei Chen, Ming Yao
    Abstract:

    BACKGROUND Percutaneous infrazygomatic radiofrequency (PIR) is a common approach used to block isolated maxillary nerve (V2) pain through the Foramen Rotundum (FR) in patients with trigeminal neuralgia (TN). Nevertheless, when using this method, there is a risk of accidental penetration of the superior orbital fissure (SOF) and the optic canal (OC) that may result in the injury of the vessels and nerves in that area, and in some severe cases may lead to blindness. According to the blocking of the external orifice of the FR and whether a curved needle was used, combined angle deviation from the path of percutaneous infrazygomatic approach, the FR to the SOF or the OC in the treatment of V2 pain, in which no research has reported the angle, we analyzed the value and application of personalized needle modification in PIR in isolated maxillary nerve pain through the FR. OBJECTIVES The following study examined the relationship between the FR and the SOF, and analyzed the clinical significance of personalized needle modification in computed tomography (CT)-guided PIR ablation of the maxillary nerve through the FR in patients with TN. STUDY DESIGN Randomized, review, clinical research study. SETTING Department of Anesthesiology and Pain Medical Center, Jiaxing, China. METHODS Three-dimensional reconstruction was performed in 88 patients and 136 patients with PIR ablation in isolated maxillary nerve pain through the FR. According to the blocking of the external orifice of the FR and whether a curved needle was used, patients were divided into 4 groups: curved-needle blocking group (CB), straight-needle blocking group (SB), straight needle no-blocking group (SN), and curved-needle no-blocking group (CN). RESULTS The results obtained revealed minimum H (shortest diameter of the FR) = 1.0 mm and minimum L (length of the FR tubes) = 3.7 mm. The distance between the external orifice of the FR and the SOF (FS) was 5.16 ± 1.33 mm. The angle A (between the radiofrequency needle and the sagittal plane) was 39 ± 3.95°; the angle between the canthomeatal line and the CT scan line (ACT) was 58.99 ± 6.23°; the puncture depth (LS) was 63.99 ± 4.24 mm; the deviation angle of the misplacement into the SOF (SAF) was 2.96 ± 0.71°; the deviation angle of the misplacement into the OC (OAF) was 4.95 ± 0.73°. In addition, the postoperative Numeric Rating Scale scores in the CB group were significantly lower compared with the SB group, whereas the probability of entering the SOF in the CB group was significantly lower compared with the SB group. The total number of punctures in the SN group was less than that in the CN group. LIMITATIONS Additional clinical data should be collected to preserve the results in future work. CONCLUSIONS The distance between the FR and the SOF or the OC was only few millimeters, and slight angle error could lead to the SOF and the OC. For patients with blockage in the path, the treatment of radiofrequency with personalized needle modification could improve the curative effect and reduce the risk of accidental SOF penetration. KEY WORDS Trigeminal neuralgia, Foramen Rotundum, superior orbital fissure, radiofrequency, personalized needle modification.

  • Application of curved needling technique in the treatment of trigeminal neuralgia by radiofrequency ablation through Foramen Rotundum with inward opening
    Chinese Journal of Neurosurgery, 2018
    Co-Authors: Bing Huang, Ming Yao, Zhiying Feng, Li Zhang, Gonghao Zhan, Dongliang Chen, Keyue Xie
    Abstract:

    Objective To observe the application effect of radiofrequency puncture needle with individualized and on-demand plastic curved needle technique in the treatment of second-branch trigeminal neuralgia by radiofrequency ablation through Foramen Rotundum with inward opening. Methods From November 2012 to May 2018, a total of 263 cases of second-branch trigeminal neuralgia were admitted to Department of Anesthesiology, the First Hospital of Jiaxing and underwent Foramen Rotundum puncture for radiofrequency ablation. All those cases were enrolled into this retrospective analysis. The paranasal sinus model of CT was used to scan the pterygoid fossa with a thickness of 3 mm, and the CT images, including the midpoint of the Foramen Rotundum tube, the internal and external hole, were selected and the puncture path was designed. The length of the line (puncture depth) and the angle between the straight line and the sagittal plane (the angle of puncture) were measured by using the ruler tool of CT software from the external hole of the Foramen Rotundum along the lateral wall of the maxillary sinus to the surface of the skin (puncturing point). If the external hole of Foramen Rotundum demonstrated an inward opening, the angle between the line and the direction of the Foramen Rotundum tube(the angle of the needle needed to bend) should be measured. The radiofrequency needle was inserted 5 mm into the self-made needle-bender, the corresponding bending angle was pulled out slightly to the side of the needle at the tip of the needle, and the individual radiofrequency needle for the patient was made. Then, puncturing under the guidance of CT followed by designed trajectory. The arc of the needle was turned to the top of the front when the needle reached the external hole of the Foramen Rotundum. Whereafter, the arc of the needle was turned to the bottom when the needle crossed the external hole. Subsequently, the needle was pushed into the Foramen Rotundum. Then, electrophysiological test was conducted for radiofrequency treatment. Results Of 263 patients undergoing radiofrequency ablation of the second branch of trigeminal nerve, 71 (27.0%) had an inward opening of the external hole of Foramen Rotundum, which needed the patient's individually designed radiofrequency puncture needle. The average bending angle was 21.3 °±3.6 °(14°-31 °). When using the individual puncture needle, the needle tip could always reach the puncture target. Using 0.1-0.5 mA current could induce obvious muscle tremor or numbness in the region innervated by the second branch of trigeminal nerve in electrophysiological test. Following radiofrequency ablation, the second-branch trigeminal neuralgia disappeared completely. Ipsilateral palate muscosal numbness and the skin numbness involving the side of the nose, upper lip and zygomatic facial region were reported. None of the patients developed numbness involving the first or third branch of trigeminal nerve. A total of 242 patients were followed up for an average of 3.2±0.6 years. The total recurrence rates at 6 months, 1 year, 2 years, 3 years and 4 years were 2.5% (6/242), 7.9% (19/242), 16.1% (39/242), 24.4% (59/242) and 33.9% (82/242), respectively. Conclusions CT-guided individually made curved needle technology allows the radiofrequency needle tip to bypass the sphenoid bone which obstructs the outer opening of Foramen Rotundum and enter the middle of Foramen Rotundum tube with inward opening, so as to improve the radiofrequency effect and reduce the recurrence rate. Key words: Trigeminal neuralgia; Radiofrequency coagulation; Foramen Rotundum; Treatment effect

  • Efficacy of CT-guided radiofrequency thermocoagulation treatment through inside versus outside of Foramen Rotundum for trigeminal maxillary neuralgia
    Chinese Journal of Anesthesiology, 2018
    Co-Authors: Keyue Xie, Bing Huang, Ming Yao, Xiaomei Ren, Yong Fei, Li Zhang, Zhiying Feng
    Abstract:

    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). 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. Key words: Electrocoagulation; Trigeminal neuralgia; Foramen ovale

  • a study of the relations of Foramen Rotundum structure direction and the approach of percutaneous puncturing of radiofrequency thermocoagulation for treating v2 of primary trigeminal neuralgia
    National Medical Journal of China, 2018
    Co-Authors: Z W Chen, Bing Huang, Ming Yao, Keyue Xie, J B, Yunyun Fei, Li Zhang
    Abstract:

    Objective To investigate the relations of Foramen Rotundum structure direction and surrounding structure systematically in order to choose the best approach of percutaneous puncturing of radiofrequency thermocoagulation for treating V2 of primary trigeminal neuralgia. Methods A total of 122 patients with V2 of primary trigeminal neuralgia for radiofrequency thermocoagulation were enrolled from August 2012 to May 2017 at the First Hospital of Jiaxing. CT scan images were observed retrospectively, to find the inside and outside of the Foramen Rotundum. The direction of Foramen Rotundum were recorded and the best approach of puncturing were analyzed. Results The images were divided into four quadrants with the semi - coronal CT scan plane of the lower margin of the zygomatic arch and the outer edge of Foramen Rotundum for horizontal axis, and the sagittal plane for the vertical axis. In 122 cases, Foramen Rotundum direction in outer upper quadrant were 77 cases(63.1%), and in outer under quadrant were 22 cases(18.0%), and in inner upper quadrant were 19 cases(15.6%), and in inner under quadrant were 4 cases(3.3%). Conclusion The most common Foramen Rotundum direction is in outer upper quadrant, so the best approach of percutaneous puncturing of radiofrequency thermocoagulation for treating V2 of primary trigeminal neuralgia is the upper side against zygomatic and the inner side against the wall of maxillary sinus. Key words: Foramen Rotundum; Trigeminal nerve; Punctures; Diagnostic techniques and procedures

Ming Yao - One of the best experts on this subject based on the ideXlab platform.

  • Personalized needle modification for CT-guided percutaneous infrazygomatic radiofrequency ablation of the maxillary nerve through the Foramen Rotundum in order to treat V2 trigeminal neuralgia.
    Journal of pain research, 2019
    Co-Authors: Bing Huang, Ming Yao, Keyue Xie, Qianying Liu, Yajing Chen, Yong Fei
    Abstract:

    Background: The computed tomography (CT)-guided radiofrequency ablation (RFA) of the maxillary nerve (V2) via Foramen Rotundum (FR) approach has been reported to offer the highest rates of pain relief in V2 trigeminal neuralgia (TN). However, the access to FR may be obstructed by the greater wing of the sphenoid bone. Objectives: We report on an optimized CT-guided percutaneous infrazygomatic of maxillary nerve through the Foramen Rotundum (FR) to treat V2 trigeminal neuralgia (TN) using personalized RFA needles based on patient’s individual CT-image parameters. Patients and methods: 176 patients with isolated V2 TN were included. If the entry of the percutaneous needle into the FR canal was blocked by the greater wing of the sphenoid bone, straight RFA needles was bent at the tip with an angle α (the angle between the straight line from the external opening of FR to the skin entry point and the long axis of the FR canal). The maxillary nerve RFA was performed after confirmation with electrophysiological tests. Pain relief in the V2 territory and TN recurrence rate were followed for up to 60 months. Results: Fifty-two patients (29.55%) required needle bending. The maxillary nerve thermal RFA resulted in analgesia in the V2 territory without affecting the V1 or V3 zone. TN recurrence rate at 6, 12, 24, 36, 48 and 60 months was 2.55%, 7.64%, 17.20%, 24.41%, 30.28% and 33.77%, respectively. Conclusion: The personalized needle modification technique for maxillary nerve RFA through FR is safe and effective to treat V2 TN.

  • The Value and Application of Personalized Needle Modification in Percutaneous Infrazygomatic Radiofrequency in Isolated Maxillary Nerve Pain through the Foramen Rotundum.
    Pain physician, 2019
    Co-Authors: Yajing Chen, Bing Huang, Qianying Liu, Qiang Zhu, Yibing Yao, Chunyan Zhu, Wei Chen, Ming Yao
    Abstract:

    BACKGROUND Percutaneous infrazygomatic radiofrequency (PIR) is a common approach used to block isolated maxillary nerve (V2) pain through the Foramen Rotundum (FR) in patients with trigeminal neuralgia (TN). Nevertheless, when using this method, there is a risk of accidental penetration of the superior orbital fissure (SOF) and the optic canal (OC) that may result in the injury of the vessels and nerves in that area, and in some severe cases may lead to blindness. According to the blocking of the external orifice of the FR and whether a curved needle was used, combined angle deviation from the path of percutaneous infrazygomatic approach, the FR to the SOF or the OC in the treatment of V2 pain, in which no research has reported the angle, we analyzed the value and application of personalized needle modification in PIR in isolated maxillary nerve pain through the FR. OBJECTIVES The following study examined the relationship between the FR and the SOF, and analyzed the clinical significance of personalized needle modification in computed tomography (CT)-guided PIR ablation of the maxillary nerve through the FR in patients with TN. STUDY DESIGN Randomized, review, clinical research study. SETTING Department of Anesthesiology and Pain Medical Center, Jiaxing, China. METHODS Three-dimensional reconstruction was performed in 88 patients and 136 patients with PIR ablation in isolated maxillary nerve pain through the FR. According to the blocking of the external orifice of the FR and whether a curved needle was used, patients were divided into 4 groups: curved-needle blocking group (CB), straight-needle blocking group (SB), straight needle no-blocking group (SN), and curved-needle no-blocking group (CN). RESULTS The results obtained revealed minimum H (shortest diameter of the FR) = 1.0 mm and minimum L (length of the FR tubes) = 3.7 mm. The distance between the external orifice of the FR and the SOF (FS) was 5.16 ± 1.33 mm. The angle A (between the radiofrequency needle and the sagittal plane) was 39 ± 3.95°; the angle between the canthomeatal line and the CT scan line (ACT) was 58.99 ± 6.23°; the puncture depth (LS) was 63.99 ± 4.24 mm; the deviation angle of the misplacement into the SOF (SAF) was 2.96 ± 0.71°; the deviation angle of the misplacement into the OC (OAF) was 4.95 ± 0.73°. In addition, the postoperative Numeric Rating Scale scores in the CB group were significantly lower compared with the SB group, whereas the probability of entering the SOF in the CB group was significantly lower compared with the SB group. The total number of punctures in the SN group was less than that in the CN group. LIMITATIONS Additional clinical data should be collected to preserve the results in future work. CONCLUSIONS The distance between the FR and the SOF or the OC was only few millimeters, and slight angle error could lead to the SOF and the OC. For patients with blockage in the path, the treatment of radiofrequency with personalized needle modification could improve the curative effect and reduce the risk of accidental SOF penetration. KEY WORDS Trigeminal neuralgia, Foramen Rotundum, superior orbital fissure, radiofrequency, personalized needle modification.

  • Application of curved needling technique in the treatment of trigeminal neuralgia by radiofrequency ablation through Foramen Rotundum with inward opening
    Chinese Journal of Neurosurgery, 2018
    Co-Authors: Bing Huang, Ming Yao, Zhiying Feng, Li Zhang, Gonghao Zhan, Dongliang Chen, Keyue Xie
    Abstract:

    Objective To observe the application effect of radiofrequency puncture needle with individualized and on-demand plastic curved needle technique in the treatment of second-branch trigeminal neuralgia by radiofrequency ablation through Foramen Rotundum with inward opening. Methods From November 2012 to May 2018, a total of 263 cases of second-branch trigeminal neuralgia were admitted to Department of Anesthesiology, the First Hospital of Jiaxing and underwent Foramen Rotundum puncture for radiofrequency ablation. All those cases were enrolled into this retrospective analysis. The paranasal sinus model of CT was used to scan the pterygoid fossa with a thickness of 3 mm, and the CT images, including the midpoint of the Foramen Rotundum tube, the internal and external hole, were selected and the puncture path was designed. The length of the line (puncture depth) and the angle between the straight line and the sagittal plane (the angle of puncture) were measured by using the ruler tool of CT software from the external hole of the Foramen Rotundum along the lateral wall of the maxillary sinus to the surface of the skin (puncturing point). If the external hole of Foramen Rotundum demonstrated an inward opening, the angle between the line and the direction of the Foramen Rotundum tube(the angle of the needle needed to bend) should be measured. The radiofrequency needle was inserted 5 mm into the self-made needle-bender, the corresponding bending angle was pulled out slightly to the side of the needle at the tip of the needle, and the individual radiofrequency needle for the patient was made. Then, puncturing under the guidance of CT followed by designed trajectory. The arc of the needle was turned to the top of the front when the needle reached the external hole of the Foramen Rotundum. Whereafter, the arc of the needle was turned to the bottom when the needle crossed the external hole. Subsequently, the needle was pushed into the Foramen Rotundum. Then, electrophysiological test was conducted for radiofrequency treatment. Results Of 263 patients undergoing radiofrequency ablation of the second branch of trigeminal nerve, 71 (27.0%) had an inward opening of the external hole of Foramen Rotundum, which needed the patient's individually designed radiofrequency puncture needle. The average bending angle was 21.3 °±3.6 °(14°-31 °). When using the individual puncture needle, the needle tip could always reach the puncture target. Using 0.1-0.5 mA current could induce obvious muscle tremor or numbness in the region innervated by the second branch of trigeminal nerve in electrophysiological test. Following radiofrequency ablation, the second-branch trigeminal neuralgia disappeared completely. Ipsilateral palate muscosal numbness and the skin numbness involving the side of the nose, upper lip and zygomatic facial region were reported. None of the patients developed numbness involving the first or third branch of trigeminal nerve. A total of 242 patients were followed up for an average of 3.2±0.6 years. The total recurrence rates at 6 months, 1 year, 2 years, 3 years and 4 years were 2.5% (6/242), 7.9% (19/242), 16.1% (39/242), 24.4% (59/242) and 33.9% (82/242), respectively. Conclusions CT-guided individually made curved needle technology allows the radiofrequency needle tip to bypass the sphenoid bone which obstructs the outer opening of Foramen Rotundum and enter the middle of Foramen Rotundum tube with inward opening, so as to improve the radiofrequency effect and reduce the recurrence rate. Key words: Trigeminal neuralgia; Radiofrequency coagulation; Foramen Rotundum; Treatment effect

  • Efficacy of CT-guided radiofrequency thermocoagulation treatment through inside versus outside of Foramen Rotundum for trigeminal maxillary neuralgia
    Chinese Journal of Anesthesiology, 2018
    Co-Authors: Keyue Xie, Bing Huang, Ming Yao, Xiaomei Ren, Yong Fei, Li Zhang, Zhiying Feng
    Abstract:

    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). 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. Key words: Electrocoagulation; Trigeminal neuralgia; Foramen ovale

  • a study of the relations of Foramen Rotundum structure direction and the approach of percutaneous puncturing of radiofrequency thermocoagulation for treating v2 of primary trigeminal neuralgia
    National Medical Journal of China, 2018
    Co-Authors: Z W Chen, Bing Huang, Ming Yao, Keyue Xie, J B, Yunyun Fei, Li Zhang
    Abstract:

    Objective To investigate the relations of Foramen Rotundum structure direction and surrounding structure systematically in order to choose the best approach of percutaneous puncturing of radiofrequency thermocoagulation for treating V2 of primary trigeminal neuralgia. Methods A total of 122 patients with V2 of primary trigeminal neuralgia for radiofrequency thermocoagulation were enrolled from August 2012 to May 2017 at the First Hospital of Jiaxing. CT scan images were observed retrospectively, to find the inside and outside of the Foramen Rotundum. The direction of Foramen Rotundum were recorded and the best approach of puncturing were analyzed. Results The images were divided into four quadrants with the semi - coronal CT scan plane of the lower margin of the zygomatic arch and the outer edge of Foramen Rotundum for horizontal axis, and the sagittal plane for the vertical axis. In 122 cases, Foramen Rotundum direction in outer upper quadrant were 77 cases(63.1%), and in outer under quadrant were 22 cases(18.0%), and in inner upper quadrant were 19 cases(15.6%), and in inner under quadrant were 4 cases(3.3%). Conclusion The most common Foramen Rotundum direction is in outer upper quadrant, so the best approach of percutaneous puncturing of radiofrequency thermocoagulation for treating V2 of primary trigeminal neuralgia is the upper side against zygomatic and the inner side against the wall of maxillary sinus. Key words: Foramen Rotundum; Trigeminal nerve; Punctures; Diagnostic techniques and procedures

Yong Zhang - One of the best experts on this subject based on the ideXlab platform.

  • the treatment of v2 v3 idiopathic trigeminal neuralgia using peripheral nerve radiofrequency thermocoagulation via the Foramen Rotundum and Foramen ovale compared with semilunar ganglion radiofrequency thermocoagulation
    Clinical Neurology and Neurosurgery, 2020
    Co-Authors: Fei Zeng, Quan Wan, Mengye Zhu, Yi Yan, Yong Zhang
    Abstract:

    Abstract Objectives To compare the advantages and disadvantages of V2 + V3 idiopathic trigeminal neuralgia using peripheral nerve radiofrequency (RF) thermocoagulation (PRF) via the Foramen Rotundum (FR) and Foramen ovale (FO) with those of semilunar ganglion RF thermocoagulation (GRF) under local anesthesia, for exploring a new and available surgical method for patients with V2 + V3 idiopathic trigeminal neuralgia. Patients and methods 102 patients with V2 + V3 idiopathic trigeminal neuralgia were enrolled in this prospective randomized controlled clinical trial, and they were divided into the PRF and GRF group randomly (n = 51 in both groups). The outcome of pain relief was assessed using the Barrow Neurological Institute (BNI) pain score, and grouped as good (BNI Class I or II, no medication required) and bad (BNI Class III–V, medication required or failed). Recurrence was defined as a relapse to a previous lower level after attainment of any higher level of pain relief. The immediate effective rate, the 2-year postoperative effective rate, the 2-year postoperative recurrence rate, and the number of complications were observed and recorded. Results Their basic conditions (age, gender ratio, side of pain, and disease duration) were similar. Furthermore, we found that the 2-year postoperative effective rate between them had no significant difference. By comparing the two groups, PRF group had the better immediate effective rate of the V2 branch and no severe complications such as corneal ulcer, however, GRF group had lower 2-year postoperative recurrence rate of the V3 branch and fewer facial swelling. Conclusion The PRF surgery, like GRF, is another prospective treatment for V2 + V3 idiopathic trigeminal neuralgia by virtue of its excellent immediate effect, accurate positioning and high safety.

  • The treatment of V2 + V3 idiopathic trigeminal neuralgia using peripheral nerve radiofrequency thermocoagulation via the Foramen Rotundum and Foramen ovale compared with semilunar ganglion radiofrequency thermocoagulation.
    Clinical neurology and neurosurgery, 2020
    Co-Authors: Fei Zeng, Quan Wan, Mengye Zhu, Yi Yan, Yong Zhang
    Abstract:

    Abstract Objectives To compare the advantages and disadvantages of V2 + V3 idiopathic trigeminal neuralgia using peripheral nerve radiofrequency (RF) thermocoagulation (PRF) via the Foramen Rotundum (FR) and Foramen ovale (FO) with those of semilunar ganglion RF thermocoagulation (GRF) under local anesthesia, for exploring a new and available surgical method for patients with V2 + V3 idiopathic trigeminal neuralgia. Patients and methods 102 patients with V2 + V3 idiopathic trigeminal neuralgia were enrolled in this prospective randomized controlled clinical trial, and they were divided into the PRF and GRF group randomly (n = 51 in both groups). The outcome of pain relief was assessed using the Barrow Neurological Institute (BNI) pain score, and grouped as good (BNI Class I or II, no medication required) and bad (BNI Class III–V, medication required or failed). Recurrence was defined as a relapse to a previous lower level after attainment of any higher level of pain relief. The immediate effective rate, the 2-year postoperative effective rate, the 2-year postoperative recurrence rate, and the number of complications were observed and recorded. Results Their basic conditions (age, gender ratio, side of pain, and disease duration) were similar. Furthermore, we found that the 2-year postoperative effective rate between them had no significant difference. By comparing the two groups, PRF group had the better immediate effective rate of the V2 branch and no severe complications such as corneal ulcer, however, GRF group had lower 2-year postoperative recurrence rate of the V3 branch and fewer facial swelling. Conclusion The PRF surgery, like GRF, is another prospective treatment for V2 + V3 idiopathic trigeminal neuralgia by virtue of its excellent immediate effect, accurate positioning and high safety.

  • ct guided selective percutaneous radiofrequency thermocoagulation via the Foramen Rotundum for isolated maxillary nerve idiopathic trigeminal neuralgia
    Journal of Neurosurgery, 2018
    Co-Authors: Quan Wan, Daying Zhang, Xintian Cao, Yong Zhang, Mengye Zhu, Wei Zuo
    Abstract:

    OBJECTIVE Although CT-guided selective percutaneous radiofrequency thermocoagulation (PRFT) via the Foramen Rotundum (FR) has been used in the clinic as a novel successful treatment for isolated, second division (maxillary nerve [V2]), idiopathic trigeminal neuralgia (ITN), there is only very limited related literature published to date. This report aims to provide more detail for physicians about this technique. METHODS Between March 2013 and April 2014, 20 patients with isolated V2 ITN refractory to or intolerant of drug treatment were treated by CT-guided selective PRFT via the FR at the First Affiliated Hospital of Nanchang University. The outcome of pain relief was assessed using the Barrow Neurological Institute (BNI) pain score, and grouped as good (BNI Class I or II, no medication required) and bad (BNI Class III-V, medication required or failed). Recurrence was defined as a relapse to a previous lower level after attainment of any higher level of pain relief. Adverse effects and complications were also monitored and recorded. RESULTS All patients (100%) obtained good pain relief including BNI Class I in 17 patients (85%) and BNI Class II in 3 patients (15%) immediately postoperatively. None of the patients were lost to follow-up. During the mean follow-up period of 24.3 months (range 18-30 months), 2 patients (10%) experienced recurring pain and the mean time until recurrence was 10.5 months (range 8-13 months). No adverse effects or complications occurred except for transient numbness restricted to the V2 dermatome in all patients (100%) and facial hematoma in 3 patients (15%). CONCLUSIONS In the current study, CT-guided selective PRFT via the FR not only achieved absolute selective lesioning to V2, but also helped patients attain successful pain relief with few adverse effects. These limited data suggest that CT-guided selective PRFT via the FR appears to be a feasible, safe, effective, and even relatively ideal treatment for isolated V2 ITN, but these findings need confirmation from further studies.

Quan Wan - One of the best experts on this subject based on the ideXlab platform.

  • the treatment of v2 v3 idiopathic trigeminal neuralgia using peripheral nerve radiofrequency thermocoagulation via the Foramen Rotundum and Foramen ovale compared with semilunar ganglion radiofrequency thermocoagulation
    Clinical Neurology and Neurosurgery, 2020
    Co-Authors: Fei Zeng, Quan Wan, Mengye Zhu, Yi Yan, Yong Zhang
    Abstract:

    Abstract Objectives To compare the advantages and disadvantages of V2 + V3 idiopathic trigeminal neuralgia using peripheral nerve radiofrequency (RF) thermocoagulation (PRF) via the Foramen Rotundum (FR) and Foramen ovale (FO) with those of semilunar ganglion RF thermocoagulation (GRF) under local anesthesia, for exploring a new and available surgical method for patients with V2 + V3 idiopathic trigeminal neuralgia. Patients and methods 102 patients with V2 + V3 idiopathic trigeminal neuralgia were enrolled in this prospective randomized controlled clinical trial, and they were divided into the PRF and GRF group randomly (n = 51 in both groups). The outcome of pain relief was assessed using the Barrow Neurological Institute (BNI) pain score, and grouped as good (BNI Class I or II, no medication required) and bad (BNI Class III–V, medication required or failed). Recurrence was defined as a relapse to a previous lower level after attainment of any higher level of pain relief. The immediate effective rate, the 2-year postoperative effective rate, the 2-year postoperative recurrence rate, and the number of complications were observed and recorded. Results Their basic conditions (age, gender ratio, side of pain, and disease duration) were similar. Furthermore, we found that the 2-year postoperative effective rate between them had no significant difference. By comparing the two groups, PRF group had the better immediate effective rate of the V2 branch and no severe complications such as corneal ulcer, however, GRF group had lower 2-year postoperative recurrence rate of the V3 branch and fewer facial swelling. Conclusion The PRF surgery, like GRF, is another prospective treatment for V2 + V3 idiopathic trigeminal neuralgia by virtue of its excellent immediate effect, accurate positioning and high safety.

  • The treatment of V2 + V3 idiopathic trigeminal neuralgia using peripheral nerve radiofrequency thermocoagulation via the Foramen Rotundum and Foramen ovale compared with semilunar ganglion radiofrequency thermocoagulation.
    Clinical neurology and neurosurgery, 2020
    Co-Authors: Fei Zeng, Quan Wan, Mengye Zhu, Yi Yan, Yong Zhang
    Abstract:

    Abstract Objectives To compare the advantages and disadvantages of V2 + V3 idiopathic trigeminal neuralgia using peripheral nerve radiofrequency (RF) thermocoagulation (PRF) via the Foramen Rotundum (FR) and Foramen ovale (FO) with those of semilunar ganglion RF thermocoagulation (GRF) under local anesthesia, for exploring a new and available surgical method for patients with V2 + V3 idiopathic trigeminal neuralgia. Patients and methods 102 patients with V2 + V3 idiopathic trigeminal neuralgia were enrolled in this prospective randomized controlled clinical trial, and they were divided into the PRF and GRF group randomly (n = 51 in both groups). The outcome of pain relief was assessed using the Barrow Neurological Institute (BNI) pain score, and grouped as good (BNI Class I or II, no medication required) and bad (BNI Class III–V, medication required or failed). Recurrence was defined as a relapse to a previous lower level after attainment of any higher level of pain relief. The immediate effective rate, the 2-year postoperative effective rate, the 2-year postoperative recurrence rate, and the number of complications were observed and recorded. Results Their basic conditions (age, gender ratio, side of pain, and disease duration) were similar. Furthermore, we found that the 2-year postoperative effective rate between them had no significant difference. By comparing the two groups, PRF group had the better immediate effective rate of the V2 branch and no severe complications such as corneal ulcer, however, GRF group had lower 2-year postoperative recurrence rate of the V3 branch and fewer facial swelling. Conclusion The PRF surgery, like GRF, is another prospective treatment for V2 + V3 idiopathic trigeminal neuralgia by virtue of its excellent immediate effect, accurate positioning and high safety.

  • ct guided selective percutaneous radiofrequency thermocoagulation via the Foramen Rotundum for isolated maxillary nerve idiopathic trigeminal neuralgia
    Journal of Neurosurgery, 2018
    Co-Authors: Quan Wan, Daying Zhang, Xintian Cao, Yong Zhang, Mengye Zhu, Wei Zuo
    Abstract:

    OBJECTIVE Although CT-guided selective percutaneous radiofrequency thermocoagulation (PRFT) via the Foramen Rotundum (FR) has been used in the clinic as a novel successful treatment for isolated, second division (maxillary nerve [V2]), idiopathic trigeminal neuralgia (ITN), there is only very limited related literature published to date. This report aims to provide more detail for physicians about this technique. METHODS Between March 2013 and April 2014, 20 patients with isolated V2 ITN refractory to or intolerant of drug treatment were treated by CT-guided selective PRFT via the FR at the First Affiliated Hospital of Nanchang University. The outcome of pain relief was assessed using the Barrow Neurological Institute (BNI) pain score, and grouped as good (BNI Class I or II, no medication required) and bad (BNI Class III-V, medication required or failed). Recurrence was defined as a relapse to a previous lower level after attainment of any higher level of pain relief. Adverse effects and complications were also monitored and recorded. RESULTS All patients (100%) obtained good pain relief including BNI Class I in 17 patients (85%) and BNI Class II in 3 patients (15%) immediately postoperatively. None of the patients were lost to follow-up. During the mean follow-up period of 24.3 months (range 18-30 months), 2 patients (10%) experienced recurring pain and the mean time until recurrence was 10.5 months (range 8-13 months). No adverse effects or complications occurred except for transient numbness restricted to the V2 dermatome in all patients (100%) and facial hematoma in 3 patients (15%). CONCLUSIONS In the current study, CT-guided selective PRFT via the FR not only achieved absolute selective lesioning to V2, but also helped patients attain successful pain relief with few adverse effects. These limited data suggest that CT-guided selective PRFT via the FR appears to be a feasible, safe, effective, and even relatively ideal treatment for isolated V2 ITN, but these findings need confirmation from further studies.

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  • Application of curved needling technique in the treatment of trigeminal neuralgia by radiofrequency ablation through Foramen Rotundum with inward opening
    Chinese Journal of Neurosurgery, 2018
    Co-Authors: Bing Huang, Ming Yao, Zhiying Feng, Li Zhang, Gonghao Zhan, Dongliang Chen, Keyue Xie
    Abstract:

    Objective To observe the application effect of radiofrequency puncture needle with individualized and on-demand plastic curved needle technique in the treatment of second-branch trigeminal neuralgia by radiofrequency ablation through Foramen Rotundum with inward opening. Methods From November 2012 to May 2018, a total of 263 cases of second-branch trigeminal neuralgia were admitted to Department of Anesthesiology, the First Hospital of Jiaxing and underwent Foramen Rotundum puncture for radiofrequency ablation. All those cases were enrolled into this retrospective analysis. The paranasal sinus model of CT was used to scan the pterygoid fossa with a thickness of 3 mm, and the CT images, including the midpoint of the Foramen Rotundum tube, the internal and external hole, were selected and the puncture path was designed. The length of the line (puncture depth) and the angle between the straight line and the sagittal plane (the angle of puncture) were measured by using the ruler tool of CT software from the external hole of the Foramen Rotundum along the lateral wall of the maxillary sinus to the surface of the skin (puncturing point). If the external hole of Foramen Rotundum demonstrated an inward opening, the angle between the line and the direction of the Foramen Rotundum tube(the angle of the needle needed to bend) should be measured. The radiofrequency needle was inserted 5 mm into the self-made needle-bender, the corresponding bending angle was pulled out slightly to the side of the needle at the tip of the needle, and the individual radiofrequency needle for the patient was made. Then, puncturing under the guidance of CT followed by designed trajectory. The arc of the needle was turned to the top of the front when the needle reached the external hole of the Foramen Rotundum. Whereafter, the arc of the needle was turned to the bottom when the needle crossed the external hole. Subsequently, the needle was pushed into the Foramen Rotundum. Then, electrophysiological test was conducted for radiofrequency treatment. Results Of 263 patients undergoing radiofrequency ablation of the second branch of trigeminal nerve, 71 (27.0%) had an inward opening of the external hole of Foramen Rotundum, which needed the patient's individually designed radiofrequency puncture needle. The average bending angle was 21.3 °±3.6 °(14°-31 °). When using the individual puncture needle, the needle tip could always reach the puncture target. Using 0.1-0.5 mA current could induce obvious muscle tremor or numbness in the region innervated by the second branch of trigeminal nerve in electrophysiological test. Following radiofrequency ablation, the second-branch trigeminal neuralgia disappeared completely. Ipsilateral palate muscosal numbness and the skin numbness involving the side of the nose, upper lip and zygomatic facial region were reported. None of the patients developed numbness involving the first or third branch of trigeminal nerve. A total of 242 patients were followed up for an average of 3.2±0.6 years. The total recurrence rates at 6 months, 1 year, 2 years, 3 years and 4 years were 2.5% (6/242), 7.9% (19/242), 16.1% (39/242), 24.4% (59/242) and 33.9% (82/242), respectively. Conclusions CT-guided individually made curved needle technology allows the radiofrequency needle tip to bypass the sphenoid bone which obstructs the outer opening of Foramen Rotundum and enter the middle of Foramen Rotundum tube with inward opening, so as to improve the radiofrequency effect and reduce the recurrence rate. Key words: Trigeminal neuralgia; Radiofrequency coagulation; Foramen Rotundum; Treatment effect

  • Efficacy of CT-guided radiofrequency thermocoagulation treatment through inside versus outside of Foramen Rotundum for trigeminal maxillary neuralgia
    Chinese Journal of Anesthesiology, 2018
    Co-Authors: Keyue Xie, Bing Huang, Ming Yao, Xiaomei Ren, Yong Fei, Li Zhang, Zhiying Feng
    Abstract:

    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). 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. Key words: Electrocoagulation; Trigeminal neuralgia; Foramen ovale

  • HEADACHE & FACIAL PAIN SECTION Original Research Article CT-Guided Percutaneous Infrazygomatic Radiofrequency Neurolysis Through Foramen Rotundum to Treat V2 Trigeminal Neuralgia
    2016
    Co-Authors: Bing Huang, Jian-guo Guo, Ming Yao, Zhiying Feng, Arzhang Zereshki, Michael Leong, Xiang Qian, Pavilion A
    Abstract:

    Objective. Percutaneous radiofrequency thermoco- agulation or neurolysis of Gasserian ganglion through Foramen ovale (FO) is the classical approach to treat trigeminal neuralgia (TN). However, it has been technically challenging when individual trigeminal sub-branch nerve block is desired through this approach. We have thus devel- oped a novel computed tomograph-guided tech- nique to block the V2 trigeminal nerve through Foramen Rotundum (FR). With this technique, we have conducted a study of 27 patients with isolated V2 TN. We hypothesize that this new technique will have comparable clinical outcome with the conven- tional FO approach. Design. Prospective study. Setting. Academic hospitals. Subjects. Twenty-seven patients with isolated clas- sical V2 TN were enrolled and divided into FO group (N = 12) and FR group (N = 15). Methods. Numeric Rating Scale (NRS) scores for facial pain, at pretreatment, immediate postopera- tive, postoperative 1 day, and 1, 6, and 12 months were recorded. The primary clinical outcome (suc- cessful pain relief with 50% or more reduction in NRS) and secondary adverse clinical outcome (hematoma, facial numbness, masticatory weak- ness, and corneal involvement) were compared and analyzed. Results. Both groups have good immediate and sustained pain relief. However, when compared with the FO group, the FR group is associated with shorter procedural time (29.2 ± 9.3 vs 45.4 ± 22.13 minutes, P < 0.05), has less nonspecific block in V1 and V3 dermatomes, and has fewer adve- rse outcomes including masticatory weakness (0/15 vs 5/12) and corneal perforation (0/12 vs 1/15). Conclusions. We have developed a novel technique to selectively block the V2 trigeminal nerve at FR. This novel FR approach may be a good alternative to the classical FO approach when an isolated V2 branch block is desired.

  • headache facial pain section original research article ct guided percutaneous infrazygomatic radiofrequency neurolysis through Foramen Rotundum to treat v2 trigeminal neuralgia
    2016
    Co-Authors: Bing Huang, Jian-guo Guo, Ming Yao, Zhiying Feng, Arzhang Zereshki, Xiang Qian, Michael S Leong, A Pavilion
    Abstract:

    Objective. Percutaneous radiofrequency thermoco- agulation or neurolysis of Gasserian ganglion through Foramen ovale (FO) is the classical approach to treat trigeminal neuralgia (TN). However, it has been technically challenging when individual trigeminal sub-branch nerve block is desired through this approach. We have thus devel- oped a novel computed tomograph-guided tech- nique to block the V2 trigeminal nerve through Foramen Rotundum (FR). With this technique, we have conducted a study of 27 patients with isolated V2 TN. We hypothesize that this new technique will have comparable clinical outcome with the conven- tional FO approach. Design. Prospective study. Setting. Academic hospitals. Subjects. Twenty-seven patients with isolated clas- sical V2 TN were enrolled and divided into FO group (N = 12) and FR group (N = 15). Methods. Numeric Rating Scale (NRS) scores for facial pain, at pretreatment, immediate postopera- tive, postoperative 1 day, and 1, 6, and 12 months were recorded. The primary clinical outcome (suc- cessful pain relief with 50% or more reduction in NRS) and secondary adverse clinical outcome (hematoma, facial numbness, masticatory weak- ness, and corneal involvement) were compared and analyzed. Results. Both groups have good immediate and sustained pain relief. However, when compared with the FO group, the FR group is associated with shorter procedural time (29.2 ± 9.3 vs 45.4 ± 22.13 minutes, P < 0.05), has less nonspecific block in V1 and V3 dermatomes, and has fewer adve- rse outcomes including masticatory weakness (0/15 vs 5/12) and corneal perforation (0/12 vs 1/15). Conclusions. We have developed a novel technique to selectively block the V2 trigeminal nerve at FR. This novel FR approach may be a good alternative to the classical FO approach when an isolated V2 branch block is desired.

  • ct guided percutaneous infrazygomatic radiofrequency neurolysis through Foramen Rotundum to treat v2 trigeminal neuralgia
    Pain Medicine, 2014
    Co-Authors: Bing Huang, Jian-guo Guo, Ming Yao, Zhiying Feng, Arzhang Zereshki, Michael Leong, Xiang Qian
    Abstract:

    Objective Percutaneous radiofrequency thermocoagulation or neurolysis of Gasserian ganglion through Foramen ovale (FO) is the classical approach to treat trigeminal neuralgia (TN). However, it has been technically challenging when individual trigeminal sub-branch nerve block is desired through this approach. We have thus developed a novel computed tomograph-guided technique to block the V2 trigeminal nerve through Foramen Rotundum (FR). With this technique, we have conducted a study of 27 patients with isolated V2 TN. We hypothesize that this new technique will have comparable clinical outcome with the conventional FO approach. Design Prospective study. Setting Academic hospitals. Subjects Twenty-seven patients with isolated classical V2 TN were enrolled and divided into FO group (N = 12) and FR group (N = 15). Methods Numeric Rating Scale (NRS) scores for facial pain, at pretreatment, immediate postoperative, postoperative 1 day, and 1, 6, and 12 months were recorded. The primary clinical outcome (successful pain relief with 50% or more reduction in NRS) and secondary adverse clinical outcome (hematoma, facial numbness, masticatory weakness, and corneal involvement) were compared and analyzed. Results Both groups have good immediate and sustained pain relief. However, when compared with the FO group, the FR group is associated with shorter procedural time (29.2 ± 9.3 vs 45.4 ± 22.13 minutes, P < 0.05), has less nonspecific block in V1 and V3 dermatomes, and has fewer adverse outcomes including masticatory weakness (0/15 vs 5/12) and corneal perforation (0/12 vs 1/15). Conclusions We have developed a novel technique to selectively block the V2 trigeminal nerve at FR. This novel FR approach may be a good alternative to the classical FO approach when an isolated V2 branch block is desired.