Balloon Compression Research Articles

Comparing success rates of the Hayman compression suture and the Bakri balloon tamponade

Background: Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality around the world. Medical treatments and uterus-sparing interventions including balloon tamponades and compression sutures are the first line options before the decision is made to perform a hysterectomy. Our aim is to compare the success rates of the Hayman compression suture and the Bakri balloon tamponade (BBT) in patients with PPH.Methods: We enrolled 82 patients who were diagnosed with uterine atony during their cesarean sections and failed to respond to uterotonic agents. The patients were treated with either a Hayman suture or a BBT.Results: The success rates of the both methods were similar (76.7% in the Hayman group and 74.4% in the BBT group). In both groups, the success rate increased with the addition of artery ligations (93% in the Hayman group and 87.2% in the BBT).Conclusion: The Hayman suture and the BBT’s performances were identical in the management of PPH due to uterine atony. All methods have pros and cons and the choice of the intervention depends on a variety of factors including the severity of bleeding, experience of the surgeon and the accessibility of the tools.

Gastrointestinal Bleeding: Update

In suspected gastrointestinal bleeding (GIB), standard operating procedures help in risk stratification, early patient management and endoscopy. If variceal bleeding is suspected, specific medication (vasoconstrictors, antimicrobial therapy) are additive to standard pharmacological management (PPI, erythromycin) prior to endoscopy. An emergency endoscopy can be performed independent of the patient's current coagulation status. Endoscopic management remains the diagnostic and therapeutic standard in GIB. Propofol can be saafely used for emergency endoscopy. Injection therapy should be combined with mechanical or thermal therapy. Recent data suggests good efficacy of novel options (over-the-scope clips, hemostatic powder, stent compression) in defined clinical situations. Biopsies can usually be obtained during index endoscopy. In severe lower GIB, early colonoscopy after intensified bowel lavage is mandated to localize bleeding. In high risk patients, insertion of a covered TIPS should be considered. In refractory or recurrent bleeding, stent insertion or balloon compression help to bridge the time for TIPS preparation.

Cardiac Magnetic Resonance to Evaluate Percutaneous Pulmonary Valve Implantation in Children and Young Adults.

Experience with cardiac magnetic resonance to evaluate coronary arteries in children and young adult patients is limited. Because noninvasive imaging has advantages over coronary angiography, we compared the effectiveness of these techniques in patients who were being considered for percutaneous pulmonary valve implantation. We retrospectively reviewed the cases of 26 patients (mean age, 12.53 ± 4.85 yr; range, 5-25 yr), all of whom had previous right ventricular-to-pulmonary artery homografts. We studied T2-prepared whole-heart images for coronary anatomy, velocity-encoded cine images for ventricular morphology, and function- and time-resolved magnetic resonance angiographic findings. Cardiac catheterization studies included coronary angiography, balloon compression testing, right ventricular outflow tract, and pulmonary artery anatomy. Diagnostic-quality images were obtained in 24 patients (92%), 13 of whom were considered suitable candidates for valve implantation. Two patients (8%) had abnormal coronary artery anatomy that placed them at high risk of coronary artery compression during surgery. Twelve patients underwent successful valve implantation after cardiac magnetic resonance images and catheterization showed no increased risk of compression. We attempted valve implantation in one patient with unsuitable anatomy but ultimately placed a stent in the homograft. Magnetic resonance imaging of coronary arteries is an important noninvasive study that may identify patients who are at high risk of coronary artery compression during percutaneous pulmonary valve implantation, and it may reveal high-risk anatomic variants that can be missed during cardiac catheterization.

Results of Percutaneous Balloon Compression in Trigeminal Pain Syndromes.

To investigate initial pain relief and subsequent recurrence after percutaneous balloon compression (PBC) and describe its association with the nature of trigeminal pain, previous procedures, or other clinical factors. A total of 222 patients with medically refractory trigeminal pain treated with PBC at Mayo Clinic Florida between 1998 and 2017 were enrolled into this study. Patients were divided into those with typical trigeminal neuralgia (TN) and those with atypical trigeminal pain. The postprocedural rate of pain recurrence and associations between patient characteristics and recurrence were studied. One hundred fifty-two patients had TN and 70 patients had atypical pain. At the last follow-up, 158 patients had excellent pain relief, 37 had good pain relief, 11 had fair pain relief, and 16 had poor pain relief. The median duration of follow-up was 31.1 months. Patients with atypical pain were less likely to have an excellent result compared with patients with typical pain (61.4% vs. 82.9%; P < 0.001). Recurrence was observed in 103 patients (46.4%) and was associated with previous procedures (hazard ratio, 1.658; 95% confidence interval, 1.09-2.49; P= 0.017). Other clinical factors were not significant. Our study demonstrates the safety and efficacy of PBC, with 88% of patients pain-free at last follow-up. Patients with atypical pain have worse outcomes, and patients with previous procedures have a higher risk of recurrence. Repeat surgery does not decrease efficacy. We recommend conservative parameter selection at the initial procedure.

Experience of the use of gasserian ganglion balloon compression in patients with trigeminal neuralgia associated with multiple sclerosis

To evaluate the efficacy of gasserian ganglion balloon compression in patients with trigeminal neuralgia associated with multiple sclerosis (MS). Eight patients (3 men, 5 women), aged from 46 to 66 years (mean age 55 years), with trigeminal neuralgia associated with MS underwent surgery. An average duration of the pain syndrome was 8,4 years. Six patients had previous surgeries due to facial pain. Percutaneous balloon compression of gasserian ganglion was performed to all patients. Follow up period was from 2 to 24 months. Six patients (75%) reported 100% of pain relief right after the surgery, 2 patients (25%) reported a significant decrease of pain (2-3 points on VAS). Pain recurrence occurred in 3 patients: in 4 months, in 12 months and in 6 months. All of them were operated repeatedly. After the surgery, hypoesthesia on the side of surgery was observed in all patients with a trend towards regression. There was no keratopathy or any complications. Percutaneous balloon compression of gasserian ganglion is an effective and minimally invasive method which can be performed repeatedly in patients with trigeminal neuralgia associated with MS.

Does combined therapy of curcumin and epigallocatechin gallate have a synergistic neuroprotective effect against spinal cord injury?

Systematic inflammatory response after spinal cord injury (SCI) is one of the factors leading to lesion development and a profound degree of functional loss. Anti-inflammatory compounds, such as curcumin and epigallocatechin gallate (EGCG) are known for their neuroprotective effects. In this study, we investigated the effect of combined therapy of curcumin and EGCG in a rat model of acute SCI induced by balloon compression. Immediately after SCI, rats received curcumin, EGCG, curcumin + EGCG or saline [daily intraperitoneal doses (curcumin, 6 mg/kg; EGCG 17 mg/kg)] and weekly intramuscular doses (curcumin, 60 mg/kg; EGCG 17 mg/kg)] for 28 days. Rats were evaluated using behavioral tests (the Basso, Beattie, and Bresnahan (BBB) open-field locomotor test, flat beam test). Spinal cord tissue was analyzed using histological methods (Luxol Blue-cresyl violet staining) and immunohistochemistry (anti-glial fibrillary acidic protein, anti-growth associated protein 43). Cytokine levels (interleukin-1β, interleukin-4, interleukin-2, interleukin-6, macrophage inflammatory protein 1-alpha, and RANTES) were measured using Luminex assay. Quantitative polymerase chain reaction was performed to determine the relative expression of genes (Sort1, Fgf2, Irf5, Mrc1, Olig2, Casp3, Gap43, Gfap, Vegf, NfκB, Cntf) related to regenerative processes in injured spinal cord. We found that all treatments displayed significant behavioral recovery, with no obvious synergistic effect after combined therapy of curcumin and ECGC. Curcumin and EGCG alone or in combination increased axonal sprouting, decreased glial scar formation, and altered the levels of macrophage inflammatory protein 1-alpha, interleukin-1β, interleukin-4 and interleukin-6 cytokines. These results imply that although the expected synergistic response of this combined therapy was less obvious, aspects of tissue regeneration and immune responses in severe SCI were evident.

Trigeminal Neuralgia.

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.

Long-term follow-up of multimodality treatment for multiple sclerosis-related trigeminal neuralgia.

The treatment for multiple sclerosis-related trigeminal neuralgia (MS-TN) is less efficacious and associated with higher recurrence rates than classical TN. No consensus has been reached in the literature on the choice procedure for MS-TN patients. The aim of this study was to assess the incidence and surgical outcomes of medically refractory MS-TN. Patient records were retrospectively reviewed for all Manitobans undergoing first procedure for medically refractory MS-TN between 2000 and 2014. Subsequent procedures were then recorded and analyzed in this subgroup of patients. The primary outcome measure was time to treatment failure. The incidence of medically refractory MS-TN was 1.2/million/year. Twenty-one patients with 26 surgically treated sides underwent first rhizotomy including 13 GammaKnife and 13 percutaneous rhizotomies comprised of ten glycerol injections and three balloon compressions. Subsequent procedures were required on 23 sides (88%), including 24 GammaKnife, 19 glycerol injections, 25 balloon compressions, two microvascular decompressions, and four open partial surgical rhizotomies with a total of 99 surgeries on 26 sides (range, 1-12 each). The majority of MS-TN patients become medically refractory and require multiple repeat surgical procedures. MS-TN procedures were associated with high rates of pain recurrence and our data suggests reoperation within 1year is often necessary. Optimal management strategy in this patient population remains to be determined. Patients need to be counseled on managing expectations as treatments commonly afford only temporary relief.

Percutaneous balloon compression for persistent or recurrent trigeminal neuralgia after microvascular decompression: personal experience of 28 patients.

The objective of this study is to investigate the long-term effects of percutaneous balloon compression (PBC) for treating persistent or recurrent trigeminal neuralgia (TN) after microvascular decompression (MVD). The clinical features, surgical findings, outcomes, and complications of 28 patients underwent PBC for TN in Nanjing Drum Tower Hospital between April 2011 and March 2015 were analyzed retrospectively. All the patients had received MVD before but they did not get cured or the symptom relapsed during follow-up. Twenty-six patients (92.9%) experienced immediate pain relief; one patient (3.6%) improved but still had occasional pain. The other one (3.6%) had no pain relief and repeat PBC was performed with complete resolution of the symptom. With a mean follow-up of 39.9months, ranging from 24 to 65months after surgery, 24 (85.7%) patients remained pain-free; three patients (11.1%) had a relapse. Surgical complications included facial numbness in 27 patients (96.4%), masseter muscle weakness in 10 patients (35.7%), and diplopia secondary to abducens nerve palsy in one patient (3.6%). None of the patients had serious surgical morbidities. PBC is a minimally invasive, safe, and effective treatment for trigeminal neuralgia, especially suitable for patients with persistent or recurrent TN after MVD.

Control of inferior vena cava injury during laparoscopic surgery using a double balloon-equipped central venous catheter: proof of concept in a live porcine model

BackgroundIatrogenic inferior vena cava (IVC) injury is a rare but potentially life-threatening complication during laparoscopic surgery. This experimental study aimed to assess the hemostatic ability of a new device, double balloon-equipped central venous (DB-CV) catheter, for IVC injury.MethodsThe DB-CV catheter comprises a triple-lumen sphincterotome combined with two dilating balloons having a diameter of 25 mm. The experimental procedures were performed in five pigs. The DB-CV catheter was inserted via the right femoral vein. For the IVC occlusion test, correct placement of the balloons was confirmed by indocyanine green fluorescence imaging, and hemodynamic data were recorded. For the IVC injury test, a 3- to 4-mm circumferential incision was created in IVC, and hemostasis was initiated using balloon inflation 5 s after the injury.ResultsHemodynamic changes were minimal, with a 20 mmHg reduction in the mean arterial pressure because of IVC occlusion. All bleeding from IVC injuries was successfully temporarily stopped by direct balloon compression, with a mean time to hemostasis of 69 s and mean blood loss of 32 ml. Subsequently, the positioning of IVC injuries between two balloons made it possible to suture the injured IVC.ConclusionsBalloon occlusion using the DB-CV catheter provides a rapid temporal hemostatic effect and can overcome the serious condition of massive hemorrhage from IVC injuries.

Safety and feasibility of sheathless transfemoral aortic valve implantation

Objective: To investigate the safety and feasibility of sheathless transfemoral aortic valve replacement (TAVR). Methods: In this prospective study, we enrolled 23 patients with severe aortic stenosis (AS) who were inoperable or at high-risk for surgical aortic valve replacement operation in Fuwai hospital From September 2012 to June 2015. Multislice spiral CT and angiography of femoral artery showed that all patients had minimal femoral artery diameters (<6.5 mm) and severe calcification which was not suitable for transfemoral TAVR through sheath. We attempted to apply the sheathless transfemoral TAVR using Venus-A prosthesis without sheath insertion, and procedure related complication during the procedure and hospital stay were observed. Results: The 6 mm×30 mm balloon was used for femoral artery predilation in 1 patient with iliofemoral artery stenosis before delivery system was transported. In the other 22 patients, the delivery system was transported directly. A total of 21 patients finished TAVR with transfemoral sheathless technique. In 2 patients, prosthesis was unable to fully expand after release due to severe valve calcification, and patients received urgent surgical aortic valve replacement. One patient had valve dislocation into the ascending aorta that was not related to the sheathless replacement technique, and delivery system and Venus-A valve were removed after femoral artery was opened surgically, and repeated sheathless TAVR implantation was performed and was successful. Moderate aortic regurgitation occurred in 2 patients immediately after procedure, and trace or mild aortic regurgitation was detected in rest of the patients. One patient had puncture site rupture and bleeding after procedure, and was successfully treated by balloon compression without blood transfusion. Complete atrioventricular block occurred in 3 patients within 24 hours after procedure and lasted after 48-72 hours, permanent pacemakers were implanted in these patients. Conclusion: The sheathless transfemoral technique in TAVR is safe and feasible in severe aortic stenosis patients with small access vessel diameter.

Long-term outcome of percutaneous balloon compression for trigeminal neuralgia patients elder than 80 years: A STROBE-compliant article.

This article evaluates the long-term outcome of percutaneous balloon compression (PBC) for trigeminal neuralgia (TN) patients elder than 80 years. A total of 138 elderly patients aged above 80 years with primary TN, who were admitted to Neurosurgery Department, Hangzhou First People's Hospital from January 2007 to December 2011 for PBC treatment, were retrospectively analyzed in this study. The postoperative cure rate of immediate pain was 98.6% (Barrow Neurological Institute [BNI] classes I, II); according to the follow-up, the pain cure rates at 1, 2, 3, 4, and 5 years after surgery were 93.5%, 90.4%, 84.7%, 80.4%, and 72.9%, respectively. In our group, postoperative diplopia was reported in 1 case, masticatory muscle weakness in 3 cases, and herpes labialis in 19 cases. A total of 100% of pain-cured patients exhibited facial numbness and facial hypoesthesia. No serious complications occurred in this group of patients. PBC is an effective and safe procedure for TN treatment and can be employed as the preferred regimen for elderly TN patients aged above 80 years in poorer physical condition.

206 Percutaneous Balloon Compression as Treatment to Trigeminal Neuralgia

Abstract INTRODUCTION Percutaneous balloon compression of the Gasserian ganglionic has been used to treat Trigeminal Neuralgia (TN) since 1983. METHODS We performed a retrospective study on 222 patient's records which have received 242 procedures of Percutaneous Balloon Compression (PBC) as treatment for TN. A 6 months follow-up period after surgery was needed to be included in the study. They were operated at Functional Neurosurgery Unit in Brazil from February 2002 to July 2016. RESULTS &gt;The patient's age ranged from 29 to 91 years (mean, 62, 2 years), 43% were males and 57% were females. Rare cases of bilateral trigeminal neuralgia were seen in 5 patients. Immediately after surgery, 193 (79,7%) patients became pain-free and 34 (14%) patients became pain free during the following 4 days. Carbamazepine was suspended in 93.7% of cases. Out of the total, only 13 (5,37%) patients related residual pain on follow-up. Hypoesthesia was reported after 83,8% of procedures. In addition, bradycardia was seen in 58,1% of cases during foramen ovale puncture. Transitory complications such as diplopia (2,47%), otalgia (1,23%) and tinnitus (1,23%) were reported. Regarding to balloon appearance, pear and dumb-bell shapes were detected in 74,8% and 7,4% of procedures, respectively. Only 15 (6,19%) patients needed a reoperation due to pain persistence. CONCLUSION PBC showed to be an effective and safe technique which provides high rates of pain relief (93,7%) in the following 6 months after surgery. The Carbamazepine's use was markedly reduced (93,7%). In addition, relapse of pain occurred in few cases (5,37%). Complications were minor and transitory. Comparing statistically, we can stat that the balloon shapes (82,2%) and hypoesthesia (83,8%) findings had a positive influence on pain relief rate (93,7%). Our findings support that PBC should be considered as primary surgical treatment of trigeminal neuralgia.

Factors Determining the Outcome in Trigeminal Neuralgia Treated With Percutaneous Balloon Compression.

To analyze 3T magnetic resonance imaging (MRI) findings and clinical features of patients with trigeminal neuralgia (TN) who underwent percutaneous balloon compression and to determine whether these findings had an impact on prognosis of TN. A retrospective review of patients with TN who underwent percutaneous balloon compression in the Neurosurgery Department at Istanbul Faculty of Medicine between January 1, 2007, and January 1, 2016, was undertaken. Of 105 patients who underwent percutaneous balloon compression, 27 patients who received surgical treatment for the first time for typical TN were included in the study. Follow-up data, clinical features, and 3T MRI findings were analyzed retrospectively. MRI findings and clinical features of patients with and without recurrence of TN were compared. The correlation between fractional anisotropy (FA) values and recurrence was investigated. During follow-up, 9 (33%) patients had recurrence. The patients with recurrence had longer duration of symptoms (P= 0.032), higher FA difference (P= 0.042), and higher FA difference rate (P= 0.023). A trend toward early recurrence was found in patients with higher FA difference rate, although this was not significant (P=0.051, R= 0.319). Symptom duration was longer and microstructural changes were more apparent in patients with recurrence. In addition to age, comorbidities, and other clinical and radiographic features, symptom duration and FA values obtained with 3T MRI might be valuable information in surgical decision making.

Analysis of the treatment of 34 cases with cesarean scar pregnancy

Objective To explore the diagnosis and treatment for the incision cesarean section scar pregnancy(CSP). Methods The clinical data of 34 patients with CSP admitted were retrospectively analyzed, and analyzed the methods of diagnosis and treatment of CSP. Results Our results showed that 9 cases after treatment with mifepristone combined with suction palace obtained success, 2 cases of bleeding assisted with balloon compression; 8 cases after mifepristone combined hysteroscopy under suction palace treatment obtained success, 1 case was failed and transfer to laparotomy. Mifepristone combined with transvaginal lesion resection of scar pregnancy was succeed in 9 cases, 2 cases were failed, of which 1 case was bleeding more and transfer to laparotomy, 1 case was confirmed remaining during a review after half a month open.7 cases were succeed in the transabdominal lesion resection of pregnancy (3 cases of transit); without hysterectomy; 3 cases were turn to the superior hospital for treatment of intervention.The statistical results showed that no statistical significant difference was obtained among the scores of different age, length of hospital stay, hospital expenses and rescue of shock in different teams of surgery.For the haemorrhage amount, the bleeding was at least in hysteroscopy group, and was at most in abdominal resection of lesions group (rescue of shock was on the high side). Conclusion Uterine scar pregnancy is a relatively rare and dangerous clinical special type of ectopic pregnancy, early diagnosis and appropriate therapeutic strategy are important. The mifepristone combined with suction palace and resection of the pregnancy lesions are safe and effective method for treatment. Key words: Cesarean section; Pregnancy; Cicatrix

An experimental animal model for percutaneous procedures used in trigeminal neuralgia

ObjectThis study describes an experimental rabbit model that allows the reproduction of percutaneous operations that are used in patients with trigeminal neuralgia (TN). Attention was given to an exact anatomical description of the rabbit’s middle cranial fossa as well as the establishment of conditions for a successful procedure.MethodsMorphometric measurements were taken from 20 rabbit skulls and CT scans. The anatomy of the trigeminal nerve, as well as its surrounding structures, was assessed by bilateral dissection of 13 New Zealand white rabbits (NWR). An ideal approach of placing a needle through the foramen ovale to reach the TG was sought. Validation of correct placement was realized by fluoroscopy and confirmed by dissection.ResultsPrecise instructions for successful reproduction of percutaneous procedures in NWR were described. According to morphological measurements, for balloon compression of the trigeminal ganglion (TG) the maximal diameter of an introducing cannula is 1.85 mm. The diameter of an empty balloon catheter should not exceed 1.19 mm, and the length of the inflatable part of the balloon can range up to 4 mm. For thermocoagulation the needle electrodes must not exceed an external diameter of 1.39, mm and the length of the non-insolated tip can range up to 4 mm. Glycerol rhizolysis can be achieved because the trigeminal cistern in the NWR is a closed space that allows a long dwelling time (>10 min) of the contrast agent.ConclusionsAn experimental NWR model intended for the reproduction of percutaneous procedures on the TG has been meticulously described. This provides a tool that enables further standardized animal research in the field of surgical treatment of TN.

Use of multi-lumen catheters to preserve injected stem cell viability and injectant dispersion.

Infusion catheters, when used with balloons, are susceptible to compression of the catheter lumen. A consequence is that shear stress is increased in the fluid that passes through the lumen. When the injected fluid contains viable cells, hemolysis of the cells can result. This study investigates the effect of a new injection catheter design which is intended to resist the deleterious effect of balloon compression on cell viability for various flowrates, balloon pressures, and fluid viscosity values. Two types of catheters were employed for the study; a standard single-lumen device and a newly designed multi-lumen alternate. Experimental and numerical simulations show that for a single-lumen injection catheter, balloon pressures in excess of 7-8atm have the potential for causing hemolysis for flows of approximately 1-4ml/min. The critical balloon pressure is dependent on the viscosity of the cell-carrying fluid and the injectant flowrate. Higher injection rates and viscosities lead to lower threshold balloon pressures. The results show a sharp rise in cell death when pressures rose above approximately 7atm. On the other hand, the multi-lumen design was shown to resist hemolysis for all tested and simulated balloon pressures and flowrates up to 10ml/min. Experimental results confirmed the numerical findings that hemolysis-causing shear stress was not found with the multi-lumen, up to 12atm. This study indicates that a pressure-resistant multi-lumen catheter better preserves cell viability compared to the standard.

Stereotactic radiosurgery for idiopathic glossopharyngeal neuralgia: an international multicenter study

OBJECTIVE The goal of this study was to evaluate the outcomes of Gamma Knife stereotactic radiosurgery (SRS) when used for patients with intractable idiopathic glossopharyngeal neuralgia. METHODS Six participating centers of the International Gamma Knife Research Foundation identified 22 patients who underwent SRS for intractable glossopharyngeal neuralgia between 1998 and 2015. The median patient age was 60 years (range 34-83 years). The median duration of symptoms before SRS was 46 months (range 1-240 months). Three patients had unsuccessful prior surgical procedures, including microvascular decompression (MVD) (n = 2) and balloon compression (n = 1). The radiosurgical target was the glossopharyngeal meatus. The median maximum dose was 80 Gy. RESULTS The median follow-up was 45 months after SRS (range 6-120 months). Twelve patients (55%) had < 4 years of follow-up. Thirteen patients (59%) had initial complete pain relief at a median of 12 days after SRS (range 1-60 days). Three patients (14%) had partial pain relief at a median of 70 days after SRS (range 60-90 days). Six patients (27%) had no pain relief. Among 16 patients with initial pain relief, 5 maintained complete pain relief without medication (Barrow Neurological Institute [BNI] pain intensity score Grade I), 1 maintained occasional pain relief without medication (BNI Grade II), 3 maintained complete pain relief with medication (BNI Grade IIIb), and 7 patients had pain recurrence at a median of 20 months after SRS (range 6-120 months). The rates of maintenance of adequate pain relief (BNI Grades I-IIIb) were 63% at 1 year, 49% at 2 years, 38% at 3 years, 38% at 5 years, and 28% at 7 years. When 7 patients without pain recurrence within 4 years of follow-up were excluded, the rates of maintenance of adequate pain relief were 38% at 5 years and 28% at 7 years. Ten patients required additional procedures (MVD, n = 4; repeat SRS, n = 5; glossopharyngeal nerve block, n = 1). Four of 5 patients who underwent repeat SRS maintained pain relief (BNI Grade I, n = 3; and BNI Grade IIIb, n = 1). No adverse effects of radiation were observed after a single SRS. Two patients developed hyperesthesia in the palatoglossal arch 5 and 8 months after repeat SRS, respectively. CONCLUSIONS Stereotactic radiosurgery for intractable, medically refractory glossopharyngeal neuralgia provided lasting pain reduction in 55% of patients after 1 or 2 SRS procedures. Patients who had a poor response or pain recurrence may require additional procedures such as repeat SRS, MVD, nerve blocks, or nerve section. No patient developed changes in vocal cord function or swallowing disorders after SRS in this study.

Observation of the hemostatic effect of balloon compression on the puncture site in cancer patients with peripherally inserted central catheter inserted by modified Seldinger puncture technique

Objective To investigate the hemostatic effect of balloon compression on the puncture site in cancer patients with peripherally inserted central catheter (PICC) inserted by ultrasound-guided modified Seldinger technique (MST). Methods Between October 2015 to January 2016, 50 cancer patients who accepted PICC inserted by ultrasound-guided MST were assigned into test group and control group respectively according to the admission time. Each group contained 25 cases. Balloon compression method was used to stop bleeding of the puncture point in the test group, while bandage compression hemostasis adopted in the control group. Results The incidence of bleeding on puncture site in the last 24 h of PICC placement was 28% (7/25) in the test group, while 68% (17/25) in the control group, and there were statistical differences between the groups (Z=-2.653, P 0.05). The incidence of limb swelling or numbness in the test group was 8% (2/25),which was lower than 32% (8/25) in the control group, and the difference had statistical significance (χ2=4.5, P < 0.05). Conclusions Balloon compression method can reduce the bleeding ratio of puncture site in cancer patients with PICC inserted by ultrasound-guided MST, and can relieve limb swelling or numbness. It is simple and safe in operation and can be easily accepted by the patients. Key words: Neoplasms; Catheterization, peripheral; Hemostasis; Errhysis; Balloon comprssion

Comparison of Percutaneous Retrogasserian Balloon Compression and Gamma Knife Radiosurgery for the Treatment of Trigeminal Neuralgia in Multiple Sclerosis

We compared and evaluated percutaneous retrogasserian balloon compression (PBC) and Gamma Knife radiosurgery (GKRS) for treatment of trigeminal neuralgia (TN) in patients with multiple sclerosis (MS). In this single-center, retrospective comparative study, 202 patients with MS and concomitant TN were evaluated. A minimum follow-up of 24 months was required. Patients with a history of microvascular decompression or previous intervention were excluded. Between February 2009 and December 2013, 78 PBC procedures and 124 first-dosage GKRS procedures were performed. PBC procedures were successfully completed in all cases. The 2 groups were compared with regard to initial effect, duration of effect, and complications including type and severity. Immediate pain relief occurred in 87% of patients treated with PBC and in 23% of patients treated with GKRS. Kaplan-Meier plots for the 2 treatment modalities were similar. The 50% recurrence rate was at 12 months for the PBC group and 18 months for the GKRS group. Complication (excluding numbness) rates were 3% for GKRS and 21% for PBC. The difference was statistically significant (χ2 test, P= 0.03). PBC and GKRS are effective techniques for treatment of TN in patients with MS. Fewer complications and superior long-term relief were associated with GKRS. We consider GKRS as the first option for the treatment of TN in patients with MS, reserving PBC for patients with acute, intractable pain.