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You S, Qin X, Zhao G, Feng Z. Personalized 3D Printed Tooth-Supported Template as a Novel Strategy for Radiofrequency Thermocoagulation for Trigeminal Neuralgia After the Failure of CT-Guided Puncture. J Pain Res 2024; 17:2347-2356. [PMID: 38983246 PMCID: PMC11232956 DOI: 10.2147/jpr.s449447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 06/15/2024] [Indexed: 07/11/2024] Open
Abstract
Background Trigeminal neuralgia (TN) is a common form of craniofacial pain, and Radiofrequency thermocoagulation (RFT) has become a commonly utilized treatment modality for TN. However, the complex anatomical configuration of the maxillofacial region and the difficulties inherent in positioning the neck in a hyperextended manner can present challenges for CT-guided punctures. Aim The objective of this study is to assess the effectiveness and safety of 3D printed tooth-supported template(3D-PTST) guided RFT in patients who have previously undergone unsuccessful CT-guided puncture. Methods Patients with TN undergoing RFT at the Department of Pain Medicine, PLA General Hospital, from January 2018 to January 2023, were assessed. 3D-PTST guided RFT was employed as an alternative when percutaneous puncture failed. Clinical, demographic, and follow-up data were collected. The duration of the procedure was determined by subtracting the time of anesthesia administration from the time of surgical drape removal. Pain intensity was assessed using the Numerical Rating Scale-11 scale. Treatment effects were evaluated utilizing the Barrow Neurological Institute scale. Incidences of complications related to RFA were documented. Results Six TN patients underwent 3D-PTST guided RFT. With tooth-supported template guidance, five patients achieved therapeutic target puncture in one attempt with one CT scan. One patient required two attempts with two CT scans. Operation duration ranged from 18 to 46 mins (mean 30 mins). All completed 3D-PTST-guided RFT without difficulty, significantly improving pain symptoms. Four patients had no pain recurrence at 12, 18, 36 and 37 months follow-up, respectively. Recurrence occurred in two patients (at 1 and 13 months). No serious treatment-related complications were observed. Conclusion 3D-PTST guided RFT is an effective, repeatable, safe, and minimally invasive treatment method for patients with TN who have failed due to difficulty in puncture.
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Affiliation(s)
- Shaohua You
- Department of Pain Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Xiaoyan Qin
- Department of Clinical Laboratory, Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, 100049, People's Republic of China
| | - Guoli Zhao
- Department of Pain Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Zeguo Feng
- Department of Pain Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
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Acevedo-Gonzalez J, Perez-Ocampo JJ, Bautista-Piñeros MA, Acosta-Rivas SDLA. Percutaneous Continuous Radiofrequency Versus Pulsed Radiofrequency Thermorhizotomy for the Treatment of Neuralgia of the Trigeminal Nerve: A Retrospective Observational Study. Cureus 2024; 16:e54830. [PMID: 38529444 PMCID: PMC10963050 DOI: 10.7759/cureus.54830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVES Trigeminal neuralgia (TN) represents one of the most powerful manifestations of neuropathic pain. The diagnostic criteria, as well as its therapeutic modalities, stand firmly established. The percutaneous radiofrequency thermorhizotomy of the gasserian ganglion and posterior root of the trigeminal nerve stands as a widely employed procedure in this context. In this retrospective observational investigation, we undertake a comparative analysis of patients subjected to treatment employing continuous radiofrequency (C-rF) versus pulsed radiofrequency (P-rF). MATERIALS AND METHODS A cohort of 128 patients afflicted with essential neuralgia of the trigeminal nerve, all under the care of the distinguished author (JCA), underwent percutaneous radiofrequency thermorhizotomy between the years 2005 and 2022. They were stratified into two cohorts: Group 1 encompassed 76 patients treated with C-rF, while Group 2 comprised 52 patients subjected to P-rF intervention. All participants met the stringent inclusion and exclusion criteria for TN, with a notable concentration in the V2 and V3 territories accounting for 60% and 45%, respectively. The post-procedural follow-up period exhibited uniformity, spanning from six months to 16 years. Preceding the intervention, all patients uniformly reported a visual analog scale (VAS) score surpassing 6/10. Additionally, everyone had been undergoing pharmacological management, involving a combination of antineuropathic agents and low-potency opioids. RESULTS The evaluation of clinical improvement was conducted across three temporal domains: the immediate short-term (less than 30 days), the intermediate-term (less than one year), and the prolonged-term (exceeding one year). In the short term, a noteworthy alleviation of pain, surpassing the 50% threshold, was evident in most patients (94%), a similarity observed in both cohorts (98% in Group 1 and 90% in Group 2). The VAS revealed an average rating of 3/10 for Group 1 and 2/10 for Group 2. Moving to the intermediate term, more than 50% improvement in pain was registered in 89% of patients (92% in Group 1 and 86% in Group 2). The mean VAS score stood at 3.5/10, marginally higher in Group 2 at 4/10 compared to 3/10 in Group 1. In the final assessment, a 50% or greater reduction in pain was reported by 75% of patients, with no discernible disparity between the two cohorts. Among the cohort, 18 individuals necessitated a subsequent percutaneous intervention (10 in Group 1 and eight in Group 2), while microvascular decompression was performed on six patients (equitably distributed between the two groups), and radiosurgery was administered to three patients in Group 1. CONCLUSIONS Percutaneous radiofrequency thermorhizotomy emerges as an efficacious modality for addressing essential TN. The employment of continuous radiofrequency yields superior long-term outcomes, albeit accompanied by sensitive manifestations that may prove discomforting. Pulsed radiofrequency demonstrates commendable clinical efficacy with a diminished incidence of complications, rendering it a viable option even for other manifestations of facial pain.
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Affiliation(s)
- Juan Acevedo-Gonzalez
- Neurosurgery, San Ignacio University Hospital, Pontifical Xavierian University, Bogota, COL
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Chumnanvej S, Chumnanvej S, Tripathi S. Assessing the benefits of digital twins in neurosurgery: a systematic review. Neurosurg Rev 2024; 47:52. [PMID: 38236336 DOI: 10.1007/s10143-023-02260-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/17/2023] [Accepted: 12/22/2023] [Indexed: 01/19/2024]
Abstract
Digital twins are virtual replicas of their physical counterparts, and can assist in delivering personalized surgical care. This PRISMA guideline-based systematic review evaluates current literature addressing the effectiveness and role of digital twins in many stages of neurosurgical management. The aim of this review is to provide a high-quality analysis of relevant, randomized controlled trials and observational studies addressing the neurosurgical applicability of a variety of digital twin technologies. Using pre-specified criteria, we evaluated 25 randomized controlled trials and observational studies on the applications of digital twins, including navigation, robotics, and image-guided neurosurgeries. All 25 studies compared these technologies against usual surgical approaches. Risk of bias analyses using the Cochrane risk of bias tool for randomized trials (Rob 2) found "low" risk of bias in the majority of studies (23/25). Overall, this systematic review shows that digital twin applications have the potential to be more effective than conventional neurosurgical approaches when applied to brain and spinal surgery. Moreover, the application of these novel technologies may also lead to fewer post-operative complications.
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Affiliation(s)
- Sorayouth Chumnanvej
- Neurosurgery Division, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Siriluk Chumnanvej
- Department of Anesthesiology and Operating Room, Phramongkutklao Hospital, Bangkok, Thailand
| | - Susmit Tripathi
- Department of Neurology, New York Presbyterian-Weill Cornell Medical Center, New York, NY, USA.
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Wang Z, Su X, Yu Y, Wang Z, Li K, Gao Y, Tian Y, Du C. A review of literature and meta-analysis of one-puncture success rate in radiofrequency thermocoagulation with different guidance techniques for trigeminal neuralgia. Eur J Med Res 2022; 27:141. [PMID: 35933404 PMCID: PMC9356501 DOI: 10.1186/s40001-022-00758-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Radiofrequency thermocoagulation (RFT) is a type of Gasserian ganglion-level ablative intervention that is used for the treatment of trigeminal neuralgia. Guidance technologies are used to assist in the cannulation of the foramen ovale (FO) or foramen rotundum (FR) target. We conducted a systematic review to assess the value of different guidance technologies for RFT. METHODS We searched PubMed, Embase, the Cochrane database, Web of Science, and PROSPERO for studies published from January 2005 until December 2020. Randomized or nonrandomized comparative studies and nonrandomized studies without internal controls were included. The Cochrane Risk of Bias Tool and the nonrandomized studies of interventions-I tool were used to assess individual study characteristics and overall quality. RESULTS Our query identified 765 publications, and we were able to analyze 11 studies on patients suffering from trigeminal neuralgia. Only one study involved randomized controlled trials, whereas the others featured nonrandomized designs, predominantly before-and-after comparisons. Most of them were observational studies. A total of 222 participants were included, with a median number (range) of 20 (3-53) participants. The objective response rate (ORR) of the one-puncture success rate of RFT using puncture guidance for trigeminal neuralgia was 92% [95% CI (0.79-1), P < 0.001]. Statistically significant differences were observed in the cannulation and operation times between the guided and manual puncture groups (P < 0.001). CONCLUSIONS RFT with puncture guidance technology has an absolute advantage in puncturing the foramen ovale or foramen rotundum.
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Affiliation(s)
- Zhengming Wang
- Department of Neurosurgery, The Third Hospital of Jilin University & China-Japan Union Hospital, No. 126, Xiantai Street, Changchun, 130033, China
| | - Xu Su
- Department of Neurosurgery, The Third Hospital of Jilin University & China-Japan Union Hospital, No. 126, Xiantai Street, Changchun, 130033, China
| | - Yin Yu
- Department of Neurosurgery, The Third Hospital of Jilin University & China-Japan Union Hospital, No. 126, Xiantai Street, Changchun, 130033, China
| | - Zhijun Wang
- Department of Pediatric Surgery, The First Hospital of Jilin University, Changchun, China
| | - Kai Li
- Department of Anesthesia, The Third Hospital of Jilin University & China-Japan Union Hospital, Changchun, China
| | - Yufei Gao
- Department of Neurosurgery, The Third Hospital of Jilin University & China-Japan Union Hospital, No. 126, Xiantai Street, Changchun, 130033, China
| | - Yu Tian
- Department of Neurosurgery, The Third Hospital of Jilin University & China-Japan Union Hospital, No. 126, Xiantai Street, Changchun, 130033, China.
| | - Chao Du
- Department of Neurosurgery, The Third Hospital of Jilin University & China-Japan Union Hospital, No. 126, Xiantai Street, Changchun, 130033, China.
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Wang Z, Cheng M, Su X, Li K, Wang G, Gao Y, Du C, Tian Y. Identifying a Novel Critical Access Difficulty Factor in Percutaneous Radiofrequency Rhizotomy for Trigeminal Neuralgia: Pterygoid Process Ridge. Oper Neurosurg (Hagerstown) 2022; 22:440-449. [PMID: 35297796 DOI: 10.1227/ons.0000000000000169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Percutaneous stereotactic radiofrequency rhizotomy (PSR) is an ablative procedure for trigeminal neuralgia (TN). The anatomic structures that pass through, or around, the foramen ovale (FO) play vital roles in the success rate of PSR. The presence of a variant pterygoid process ridge (PPR) obscuring the FO renders the cannulation procedure difficult but had not been described in the literature before. OBJECTIVE To identify the variations of the PPR to assess cannulation difficulty. METHODS Fifty seven FOs of 57 patients with TN (TN group) and 438 FOs of 232 patients without TN (non-TN group) were analyzed using 3-dimensional computed tomography reconstruction images of cranial bases. Three-dimensional printer models were also used for TN patients with PPR-obscured FOs. Measurements were obtained for shape, size, and morphometric variability effect on cannulation. RESULTS We identified 5 PPR-obscured FOs (8.8%) in the TN group and 32 FOs (7.3%) in the non-TN group. In the TN group, the transverse diameter obstruction ranged from 19.2% to 39.7% in 4 patients, and 1 case was 100%. Of particular note, approximately one-quarter to one-third of FO preset targets were affected by PPR. CONCLUSION A PPR-obscured FO represents a new confounding factor in the conduct of PSR. Confirming the PPR-obscured FO is a critical step in improving the effectiveness of puncture target presetting, ie, evaluating the target with actual FO data is an improvement over the use of surgical view FO data. Discernment of the PPR can improve the success rate of difficult-to-access FO punctures, thereby rendering PSR more effective.
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Affiliation(s)
- Zhengming Wang
- Department of Neurosurgery, The Third Hospital of Jilin University and China-Japan Union Hospital, Changchun, China
| | - Min Cheng
- Department of Radiology, The Third Hospital of Jilin University and China-Japan Union Hospital, Changchun, China
| | - Xu Su
- Department of Neurosurgery, The Third Hospital of Jilin University and China-Japan Union Hospital, Changchun, China
| | - Kai Li
- Department of Anesthesia, The Third Hospital of Jilin University and China-Japan Union Hospital, Changchun, China
| | - Guan Wang
- Department of Neurosurgery, The Third Hospital of Jilin University and China-Japan Union Hospital, Changchun, China
| | - Yufei Gao
- Department of Neurosurgery, The Third Hospital of Jilin University and China-Japan Union Hospital, Changchun, China
| | - Chao Du
- Department of Neurosurgery, The Third Hospital of Jilin University and China-Japan Union Hospital, Changchun, China
| | - Yu Tian
- Department of Neurosurgery, The Third Hospital of Jilin University and China-Japan Union Hospital, Changchun, China
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Wang R, Han Y, Luo MZ, Wang NK, Sun WW, Wang SC, Zhang HD, Lu LJ. Accuracy study of a binocular-stereo-vision-based navigation robot for minimally invasive interventional procedures. World J Clin Cases 2020; 8:3440-3449. [PMID: 32913850 PMCID: PMC7457116 DOI: 10.12998/wjcc.v8.i16.3440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/07/2020] [Accepted: 07/18/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Medical robot is a promising surgical tool, but no specific one has been designed for interventional treatment of chronic pain. We developed a computed tomography-image based navigation robot using a new registration method with binocular vision. This kind of robot is appropriate for minimal invasive interventional procedures and easy to operate. The feasibility, accuracy and stability of this new robot need to be tested.
AIM To assess quantitatively the feasibility, accuracy and stability of the binocular-stereo-vision-based navigation robot for minimally invasive interventional procedures.
METHODS A box model was designed for assessing the accuracy for targets at different distances. Nine (three sets) lead spheres were embedded in the model as puncture goals. The entry-to-target distances were set 50 mm (short-distance), 100 mm (medium-distance) and 150 mm (long-distance). Puncture procedure was repeated three times for each goal. The Euclidian error of each puncture was calculated and statistically analyzed. Three head phantoms were used to explore the clinical feasibility and stability. Three independent operators conducted foramen ovale placement on head phantoms (both sides) by freehand or under the guidance of robot (18 punctures with each method). The operation time, adjustment time and one-time success rate were recorded, and the two guidance methods were compared.
RESULTS On the box model, the mean puncture errors of navigation robot were 1.7 ± 0.9 mm for the short-distance target, 2.4 ± 1.0 mm for the moderate target and 4.4 ± 1.4 mm for the long-distance target. On the head phantom, no obvious differences in operation time and adjustment time were found among the three performers (P > 0.05). The median adjustment time was significantly less under the guidance of the robot than under free hand. The one-time success rate was significantly higher with the robot (P < 0.05). There was no obvious difference in operation time between the two methods (P > 0.05).
CONCLUSION In the laboratory environment, accuracy of binocular-stereo-vision-based navigation robot is acceptable for target at 100 mm depth or less. Compared with freehand, foramen ovale placement accuracy can be improved with robot guidance.
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Affiliation(s)
- Ran Wang
- Department of Pain Management, Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Ying Han
- Department of Pain Management, Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Min-Zhou Luo
- Institute of Intelligent Manufacturing Technology, Jiangsu Industrial Technology Research Institute, Nanjing 210000, Jiangsu Province, China
| | - Nai-Kun Wang
- Department of Pain Management, Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Wei-Wei Sun
- Department of Pain Management, Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Shi-Chong Wang
- Department of Pain Management, Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Hua-Dong Zhang
- Institute of Intelligent Manufacturing Technology, Jiangsu Industrial Technology Research Institute, Nanjing 210000, Jiangsu Province, China
| | - Li-Juan Lu
- Department of Pain Management, Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
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