Objective To evaluate the effectiveness of three-dimensional computed tomography （3D-CT） guided radiofi＇equency trigeminal rhizotomy （RF-TR） in treatment of idiopathic trigeminal neuralgia （1TN）. Methods From ...Objective To evaluate the effectiveness of three-dimensional computed tomography （3D-CT） guided radiofi＇equency trigeminal rhizotomy （RF-TR） in treatment of idiopathic trigeminal neuralgia （1TN）. Methods From 1999 to 2001, 18 patients with ITN were treated with percutaneous controlled RF-TR. Intraoperative 3D-CT scanning was performed to guide the trajectory of the puncture. After correction of the needle tip according to the CT scans and stimulation effects, 2 to 5 lesions were made for a duration of 60-90 seconds at a temperature of 60℃ to 75℃ depending on the pain distribution and the age of patient. The needles located in foramen ovale. Pain alleviated immediately with no serious complication in all patients. The patients were followed up for an average of 31.5 months （range 24-41 months）. Acute pain relief was experienced by 17 patients after the procedure, reaching an initial success rate of 94.4%. Early （〈 6 months） pain recurrence was observed in 2 patients （11.1%）, whereas late （〉 6 months） recurrence was reported in 3 patients （16.7%）. Thirteen patients had complete pain control, with no need for medication thereafter. Five cases experienced partial pain relief, but required medication at a lower dose than in the preoperative period. Conclusion 3D-CT foramen ovale locations can raise the successful rate of puncture, enhance the safety, and reduce the incidence rate of complication.展开更多
Objective： To quantitatively identify and grade trigeminal sensory functions after 3 major surgical procedures of trigeminal neuralgia using a newly developed quantitative sensory testing technique, current perceptio...Objective： To quantitatively identify and grade trigeminal sensory functions after 3 major surgical procedures of trigeminal neuralgia using a newly developed quantitative sensory testing technique, current perception threshold measurement （CPTM）. Methods： In the current study, there were 48 trigeminal neuralgia patients without history of prior surgical treatment. These patients received one of the following 3 surgical procedures, microvascular decompression （MVD）, peripheral nerve block with alcohol （PNB）, or percutaneous radiofrequency thermocoagulation （PRFT）. The quantitative sensory testing measurement, CPTM, and conventional qualitative sensory testing measurements were performed preoperatively and postoperatively to evaluate and grade the trigeminal sensory functions All 3 major cutaneous sensory fiber types, large myelinated fibers （A beta）, small myelinated fibers （A delta） and unmyelinated fibers（C） were allowed to quantitatively evaluate and grade by CPTM. The results of the measurements were statistically analyzed using a one-way analysis of variance （single factor）. Each subject was his/her own control for comparison of the preoperative to postoperative state on the asymptomatic and symptomatic sides. Subjects were tested 48 h preoperatively and 4 weeks postoperatively. Results： PNB with alcohol and PRFT caused significant sensory dysfunction postoperatively in every fiber type, indicating damage to all fibers. On the contrary, the sensory function in all 3 fiber types was unchanged after MVD management. Conclusion： Among the 3 major surgical procedures tested, only MVD preserves sensory function in trigeminal system. CPTM is of quantitative nature on the evaluation of sensory functions of nerve fibers展开更多
Objective: To explore the pathogenesis of trigeminal neuralgia (TN) and to provide a new target for the drug treatment of TN by studying the expression of tetrodotoxin-resistant hNav1. 8 sodium channel protein in affe...Objective: To explore the pathogenesis of trigeminal neuralgia (TN) and to provide a new target for the drug treatment of TN by studying the expression of tetrodotoxin-resistant hNav1. 8 sodium channel protein in affected nerves of patients with TN. Methods: Twelve affected inferior alveolar nerves were obtained from patients with idiopathic TN, to whom the drug therapy was not effective. As negative control, one nonnal inferior alveolar nerve was obtained from patients who accepted the combined radical neck dissection with glossectomy and mandibulectomy. One muscle sample was obtained as normal control. One dorsal root ganglion from rat was as positive control. These tissues and prepared hNav1. 8 antibody were conducted immunohistochemistry response. Results: hNav1.8 channel protein was expresses in all the 12 specimens of the affected nerves of patients with TN, but not in the muscle sample and the normal inferior alveolar nerve. Conclusion: The abnormal expression of hNav1. 8 channel protein in the affected nerves of patients with TN may play an important role in the pathogenesis of TN.展开更多
文摘Objective To evaluate the effectiveness of three-dimensional computed tomography （3D-CT） guided radiofi＇equency trigeminal rhizotomy （RF-TR） in treatment of idiopathic trigeminal neuralgia （1TN）. Methods From 1999 to 2001, 18 patients with ITN were treated with percutaneous controlled RF-TR. Intraoperative 3D-CT scanning was performed to guide the trajectory of the puncture. After correction of the needle tip according to the CT scans and stimulation effects, 2 to 5 lesions were made for a duration of 60-90 seconds at a temperature of 60℃ to 75℃ depending on the pain distribution and the age of patient. The needles located in foramen ovale. Pain alleviated immediately with no serious complication in all patients. The patients were followed up for an average of 31.5 months （range 24-41 months）. Acute pain relief was experienced by 17 patients after the procedure, reaching an initial success rate of 94.4%. Early （〈 6 months） pain recurrence was observed in 2 patients （11.1%）, whereas late （〉 6 months） recurrence was reported in 3 patients （16.7%）. Thirteen patients had complete pain control, with no need for medication thereafter. Five cases experienced partial pain relief, but required medication at a lower dose than in the preoperative period. Conclusion 3D-CT foramen ovale locations can raise the successful rate of puncture, enhance the safety, and reduce the incidence rate of complication.
文摘Objective： To quantitatively identify and grade trigeminal sensory functions after 3 major surgical procedures of trigeminal neuralgia using a newly developed quantitative sensory testing technique, current perception threshold measurement （CPTM）. Methods： In the current study, there were 48 trigeminal neuralgia patients without history of prior surgical treatment. These patients received one of the following 3 surgical procedures, microvascular decompression （MVD）, peripheral nerve block with alcohol （PNB）, or percutaneous radiofrequency thermocoagulation （PRFT）. The quantitative sensory testing measurement, CPTM, and conventional qualitative sensory testing measurements were performed preoperatively and postoperatively to evaluate and grade the trigeminal sensory functions All 3 major cutaneous sensory fiber types, large myelinated fibers （A beta）, small myelinated fibers （A delta） and unmyelinated fibers（C） were allowed to quantitatively evaluate and grade by CPTM. The results of the measurements were statistically analyzed using a one-way analysis of variance （single factor）. Each subject was his/her own control for comparison of the preoperative to postoperative state on the asymptomatic and symptomatic sides. Subjects were tested 48 h preoperatively and 4 weeks postoperatively. Results： PNB with alcohol and PRFT caused significant sensory dysfunction postoperatively in every fiber type, indicating damage to all fibers. On the contrary, the sensory function in all 3 fiber types was unchanged after MVD management. Conclusion： Among the 3 major surgical procedures tested, only MVD preserves sensory function in trigeminal system. CPTM is of quantitative nature on the evaluation of sensory functions of nerve fibers
文摘Objective: To explore the pathogenesis of trigeminal neuralgia (TN) and to provide a new target for the drug treatment of TN by studying the expression of tetrodotoxin-resistant hNav1. 8 sodium channel protein in affected nerves of patients with TN. Methods: Twelve affected inferior alveolar nerves were obtained from patients with idiopathic TN, to whom the drug therapy was not effective. As negative control, one nonnal inferior alveolar nerve was obtained from patients who accepted the combined radical neck dissection with glossectomy and mandibulectomy. One muscle sample was obtained as normal control. One dorsal root ganglion from rat was as positive control. These tissues and prepared hNav1. 8 antibody were conducted immunohistochemistry response. Results: hNav1.8 channel protein was expresses in all the 12 specimens of the affected nerves of patients with TN, but not in the muscle sample and the normal inferior alveolar nerve. Conclusion: The abnormal expression of hNav1. 8 channel protein in the affected nerves of patients with TN may play an important role in the pathogenesis of TN.
