• Electric stimulation
• Neuralgia
• Numbness
• Radiofrequency ablation
• Trigeminal nerve disease
• Voltage

• effectiveness and safety
• postoperative pain relief
• procedural advancement
• radiofrequency thermocoagulation
• trigeminal neuralgia

• antidepressants
• drowsiness
• gasserian ganglion
• mandibular
• trigeminal neuralgia

Our objective was to study the clinical feasibility of Xper-CT combined with laser-assisted radiofrequency thermocoagulation in the treatment of trigeminal neuralgia.

A retrospective analysis was made of 60 patients with trigeminal neuralgia who visited the Affiliated Hospital of Binzhou Medical University from January 2019 to May 2021. According to the different surgical methods, we were divided into C-arm X-ray group and laser navigation group. The operation time, operative complications, post-operative 24 h, post-operative 3 and 6 months Barrow Neurotics Institute (BNI) score were recorded and compared.

Compared with the C-arm X-ray-guided puncture group, Xper-CT combined with laser-assisted navigation has the obvious advantages of shorter total puncture time, shorter surgical time, higher success rate of first puncture, and better surgical effect.

Radiofrequency therapy of trigeminal neuralgia with Xper-CT combined with laser-assisted navigation has a good clinical effect and can be promoted and applied.

• MRI
• Machine learning
• Radiomics
• Trigeminal neuralgia

• Humans
• Magnetic Resonance Imaging/methods
• Radiosurgery/methods
• Retrospective Studies
• Trigeminal Nerve/diagnostic imaging
• Trigeminal Neuralgia/diagnostic imaging
• Trigeminal Neuralgia/surgery

• TL1R002493 NCATS NIH HHS
• UL1TR002494 NCATS NIH HHS
• P41 EB027061 NIBIB NIH HHS
• P30 NS076408 NIBIB NIH HHS

• headache
• neuropathic pain
• percutaneous microcompression
• radiofrequency thermocoagulation
• trigeminal neuralgia

• National Key Research and Development Program of China
• National Natural Science Foundation of China

• facial pain
• glycerol
• microvascular decompression
• partial sensory rhizotomy
• radiofrequency
• trigeminal neuralgia

This experimental study evaluates the location of thoracic dorsal root ganglions (DRGs) through magnetic resonance imaging (MRI) scans, and evaluates the radiofrequency ablation (RFA) fraction of different puncture approaches on distinct DRG locations. Eight normal adult corpse specimens were used as thoracic spine specimens. An MRI examination was performed on each specimen using the following MRI sequences: STIR T2WI, fs-FRFSE T2WI, and 3D FIESTA-c. Then thoracic spine specimens (n = 14) were divided into three groups for RFA: Group A, using a transforaminal approach irrespective of DRG location; Group B, using a transforaminal, trans-lateral-zygapophysial or translaminar approach according to the DRG location; and Group C using a combination of puncture approaches. The quality of visualization of thoracic DRGs on STIR T2WI, fs-FRFSE T2WI, and 3D FIESTA-c scans were 53.5% (77/144), 88.2% (127/144), and 93.1% (134/144), respectively. In group A, the RFA fractions of the extraforaminal DRGs (N = 29), intraforaminal DRGs (N = 12) and intraspinal DRGs (N = 7) via a transforaminal approach were 72.6 ± 18.9%, 54.2 ± 24.8% and 32.9 ± 28.1% respectively. In group B, RFA of extraforaminal DRGs via a transforaminal approach (N = 43) or a trans-lateral zygapophysial approach (N = 45) led to ablation fractions of 71.9 ± 15.2% and 72.0 ± 17.9%, respectively; RFA of intraforaminal DRGs via a transforaminal approach (N = 14) or a translaminar approach (N = 16) led to ablation fractions of 57.1 ± 18.0% and 52.5 ± 20.6%, respectively; RFA of intraspinal DRGs via a transforaminal approach (N = 12) or a translaminar approach (N = 14) led to ablation fractions of 34.8 ± 24.6% and 71.8 ± 16.0%, respectively. In group C, the combined approach led to an ablation fraction for extraforaminal DRGs (N = 69) of 82.5 ± 14.1%, for intraforaminal DRGs (N = 39) of 81.5 ± 11.8%, and for intraspinal DRGs (N = 36) of 80.8 ± 13.3%. MRI can accurately assess DRG location before RFA. Adopting different and combined puncturing approaches tailored to different DRG locations can significantly increase the DRG RFA fraction.

• Bipolar radiofrequency therapy
• Expert consensus
• Pain
• Pulsed radiofrequency
• Radiofrequency therapy
• Standard radiofrequency therapy

Trigeminal neuralgia (TN) is a severe neuropathic condition that affects several elderly patients. It is characterized by uncontrolled pain that significantly impacts the quality of life of patients. Therefore, the condition should be treated as an emergency. In the majority of patients, pain can be controlled with medication; however, other treatment modalities are being explored in those who become refractory to drug treatment. The use of the trigeminal nerve block with a local anesthetic serves as an excellent adjunct to drug treatment. This technique rapidly relieves the patient of pain while medications are being titrated to effective levels. We report the efficacy and safety of percutaneous trigeminal nerve block in elderly patients with TN at our outpatient clinic.

Twenty-one patients older than 65 years with TN received percutaneous nerve block at our outpatient clinic. We used bupivacaine (1 mL/injection site) to block the supraorbital, infraorbital, superior alveolar, mental, and inferior alveolar nerves according to pain sites of patients.

All patients reported relief from pain, which decreased by approximately 78% after 2 weeks of nerve block. The effect lasted for more than 4 weeks in 12 patients and for 6 weeks in two patients. There were no complications.

Percutaneous nerve block procedure performed at our outpatient clinic provided immediate relief from pain to elderly patients with TN. The procedure is simple, has no serious side effects, and is easy to apply.

• Bupivacaine
• Emergency
• Nerve block
• Trigeminal neuralgia

There is a paucity of information regarding the specific anatomy and clinical significance of variations of foramen ovale (FO). The present study was undertaken to define this anatomy in more detail and to review the literature regarding these anatomic variations.

A total of 124 adult human dry skulls were analyzed for the variations in appearance and number of FO being noted. The length and width of the FO of both sides were determined using digital vernier calipers and area (A) was also calculated and analyzed.

Of 82 adult skulls, the values for the right side was 7.64 ± 1.194 mm, 5.128 ± 0.827 mm, and 30.808 ± 7.545 mm² and for the left side the values was 7.561 ± 1.123 mm, 5.244 ± 0.950 mm, and 31.310 ± 8.262 mm², respectively, for the mean length, width, and area of the FO. The shape of foramen was typically ovale in most of the skulls (56.70%) with some bony variations such as spine, tubercles, bony bridge/bar, and confluence.

Such variants in the FO could interfere with transcutaneous needle placement into the FO or distort anatomic relationships during approaches to the cranial base.

• Anatomic landmarks
• foramen ovale
• greater wing of the sphenoid
• middle cranial fossa
• skull base

• Trigeminal neuralgia
• obesity
• pain
• stereotactic radiosurgery

Although various cases of neuralgia and its treatments have been reported, not enough evidence is present to recommend a single type of treatment as the most effective. The patient we have dealt with experienced significant interferences in his daily life due to chronic allodynia, but the symptom could not be resolved via previously reported treatments. We report a case of which a patient who presented infraorbital neuralgia after trauma was successfully treated by a novel treatment strategy. The patient was treated by applying infraorbital nerve block and pulsed radiofrequency cautery side by side. Through this report, we evaluate proper prevention and treatment strategies for patients who develop infraorbital neuralgia through similar etiologies.

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• infraorbital nerve block
• orbital wall fracture
• pulsed radio frequency
• stellate ganglion block
• ultrasound-guided

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.

• foramen rotundum
• maxillary nerve
• radiofrequency ablation
• trigeminal neuralgia

Background: Percutaneous trans-foramen ovale (FO) radiofrequency ablation (RFA) of Gasserian ganglion (GG) is commonly used to treat V3 trigeminal neuralgia (TN). However, this intracranial approach is less selective and safe.

Objectives: To report a novel percutaneous within-FO RFA of the V3 under CT-guidance and outcomes with both bipolar and monopolar techniques.

Patients and methods: Twenty-six patients with isolated V3 primary TN and FO >6 mm in diameter underwent either monopolar (n=12) or bipolar RFAs (n=14) based on their preference. Successful analgesia over V3, residual pain, recurrent pain, and complications were compared between the two groups. The ex vivo egg albumen model was used to demonstrate the size difference in the thermocoagulation lesion created by monopolar vs bipolar electrodes.

Results: In the bipolar group, there were more cases of masticatory atonia as compared to the monopolar (P=0.104), but no residual pain was observed. In the monopolar group, there were two cases of residual pain found, which led to immediate repeat RFAs. Therefore, during the immediate post-operative period, both groups obtained 100% complete V3 analgesia with a similar risk of facial hematoma (P=0.641). During up to 27-months of post-operative follow-up, in the bipolar group, complete pain relief persisted in all patients; in the monopolar group, 1 case of recurrent pain was found at 14 months. Ex vivo study demonstrated that, at 90 °C/90 seconds of RFA, the width of lesions is significantly larger by the 6-mm spacing parallel-tip bipolar electrodes compared to the monopolar electrode (9.5±0.567 vs 5.5±0.07 mm).

Conclusion: In treating patients with isolated V3 TN and FO >6mm in diameter, this percutaneously within-FO RFA of the V3 under CT guidance is both clinically practical and effective, while bipolar RFA is associated with a lower incidence of residual and recurrent pain likely due to larger lesion sizes.

• bipolar
• foramen ovale
• mandibular nerve
• radiofrequency ablation
• trigeminal neuralgia

Trigeminal neuralgia (TN) is a severe type of neuropathic pain which is often inadequately managed using conventional therapies. In this report, we present the first case of TN treated with gasserian ganglion nerve coblation (NC).

A 58-year-old man presented with right facial pain, mostly localized in the right zygomatic zone, alveolar region, and jaws. Similar to acupuncture and shock pain, the pain lasted about five seconds after each attack before resolving unaided. A diagnosis of TN was made, after which treatment with acupuncture therapy and oral carbamazepine was given. However, the pain was not satisfactorily controlled. Subsequently, gasserian ganglion NC of the right trigeminal nerve guided by computed tomography (CT) was performed on the patient. Following this procedure, the right zygomatic, alveolar, submandibular, and cheek pain disappeared completely. The right zygomatic and alveolar areas experienced mild numbness (level II). At 1-, 2-, 3-, and 6-mo follow-ups after surgery, the patient was painless and the numbness score was level I.

CT-guided gasserian ganglion (NC) is an effective treatment for TN and is associated with less or no postoperative numbness or hypoesthesia in comparison with current standard-of-care approaches.

• Nerve coblation
• Trigeminal neuralgia
• Gasserian ganglion
• Computed tomography guided
• Case report

• Headache conditions
• Migraine
• Radiofrequency ablation

• Denervation
• facial neuralgia
• facial pain
• pulsed radiofrequency treatment

In view of the characteristics of high risk and high accuracy in cranio-maxillofacial surgery, we present a novel surgical robot system that can be used in a variety of surgeries. The surgical robot system can assist surgeons in completing biopsy of skull base lesions, radiofrequency thermocoagulation of the trigeminal ganglion, and radioactive particle implantation of skull base malignant tumors. This paper focuses on modelling and experimental analyses of the robot system based on navigation technology. Firstly, the transformation relationship between the subsystems is realized based on the quaternion and the iterative closest point registration algorithm. The hand-eye coordination model based on optical navigation is established to control the end effector of the robot moving to the target position along the planning path. The closed-loop control method, “kinematics + optics” hybrid motion control method, is presented to improve the positioning accuracy of the system. Secondly, the accuracy of the system model was tested by model experiments. And the feasibility of the closed-loop control method was verified by comparing the positioning accuracy before and after the application of the method. Finally, the skull model experiments were performed to evaluate the function of the surgical robot system. The results validate its feasibility and are consistent with the preoperative surgical planning.

• Catheter ablation
• headache
• migraine disorders

Trigeminal neuralgia (TN) is a sudden, severe, brief, stabbing, and recurrent pain within one or more branches of the trigeminal nerve. Type 1 as intermittent and Type 2 as constant pain represent distinct clinical, pathological, and prognostic entities. Although multiple mechanism involving peripheral pathologies at root (compression or traction), and dysfunctions of brain stem, basal ganglion, and cortical pain modulatory mechanisms could have role, neurovascular conflict is the most accepted theory. Diagnosis is essentially clinically; magnetic resonance imaging is useful to rule out secondary causes, detect pathological changes in affected root and neurovascular compression (NVC). Carbamazepine is the drug of choice; oxcarbazepine, baclofen, lamotrigine, phenytoin, and topiramate are also useful. Multidrug regimens and multidisciplinary approaches are useful in selected patients. Microvascular decompression is surgical treatment of choice in TN resistant to medical management. Patients with significant medical comorbidities, without NVC and multiple sclerosis are generally recommended to undergo gamma knife radiosurgery, percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation procedures. Partial sensory root sectioning is indicated in negative vessel explorations during surgery and large intraneural vein. Endoscopic technique can be used alone for vascular decompression or as an adjuvant to microscope. It allows better visualization of vascular conflict and entire root from pons to ganglion including ventral aspect. The effectiveness and completeness of decompression can be assessed and new vascular conflicts that may be missed by microscope can be identified. It requires less brain retraction.

• Cranial nerve
• microvascular decompression
• neurosurgical procedures/methods
• route entry zone
• trigeminal nerve diseases
• trigeminal neuralgia
• trigeminal neuralgia/surgery

Post-herpetic itch (PHI) is a neuropathic itch syndrome following herpes zoster. It has been reported that PHI is occasionally sufficiently severe to compromise patients’ quality of life and frequently refractory to treatment. Here, we present a case of severe chronic PHI successfully treated with supraorbital nerve block using a high concentration of tetracaine dissolved in bupivacaine.

An 82-year-old man presented with severe chronic itching in the ophthalmic branch of the left trigeminal nerve dermatome, following acute herpes zoster. The patient’s itching was unresponsive to usual medical treatments for PHI including antiepileptic drugs, topical capsaicin cream, and supraorbital nerve radiofrequency thermo-coagulation. Topical lidocaine cream could relieve the itching, but could not provide long-term relief of itching and thus failed to achieve a satisfactory result. After these conventional treatments, left supraorbital nerve block using 4% tetracaine dissolved with 0.5% bupivacaine was conducted. Afterwards, the patient experienced long-lasting resolution of the itching with improvement of sleep disturbance. A transient, mild edema of the eyelids occurred, but there were no other complications.

Peripheral nerve block using 4% tetracaine dissolved with 0.5% bupivacaine was beneficial in relieving PHI in the ophthalmic division of the trigeminal nerve.

• Peripheral nerve block
• Post-herpetic itch
• Tetracaine

• pain
• radiofrequency temperature
• radiofrequency thermocoagulation
• trigeminal nerve
• trigeminal neuralgia

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Electrocoagulation/methods
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Temperature
• Tomography, X-Ray Computed
• Treatment Outcome
• Trigeminal Neuralgia/therapy

• radiofrequency lesioning
• trigeminal neuralgia

• T32 GM008685 NIGMS NIH HHS

The aim of present paper was to discuss issues related to trigeminal neuralgia with strong emphasis on the aetiology and pathogenesis of this problem.

An electronic search of 5 databases (1965 - Oct 2012) and a hand search of peer-reviewed journals for relevant articles were performed. In addition, experience acquired from treating 3263 patients in the Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, were also summarized.

Generally, aetiological factors can be classified into 3 most popular theories that were based on: 1) Related to other disease, 2) Direct injury to the trigeminal nerve, and 3) Propagates the polyetiologic origin of the disease. In addition, two pathogenesis mechanisms of trigeminal neuralgia were proposed. First: the peripheral pathogenetic mechanism that is often induced by progressive dystrophy around the peripheral branches of the trigeminal nerve. Second, central pathogenetic mechanism which often triggered by peripheral pathogen that causes long-lasting afferent impulsation and the formation of a stable pathologic paroxysmal type irritation focus on the central nerve system (CNS).

Patients with susceptive trigeminal neuralgia should be examined carefully by specialists who have expertise in assessing and diagnosing of possible pathological processes and be able to eliminate the contributing factors so the trigeminal neuralgia can be properly managed.

• trigeminal ganglion
• trigeminal nerve
• trigeminal neuralgia
• trigeminal nuclei.