Masticatory Muscle Weakness Research Articles

Analysis of the Therapeutic Efficacy of Percutaneous Balloon Double Compression for the Treatment of Recurrent Trigeminal Neuralgia

BACKGROUND: A more secure and efficacious therapy than has been developed so far is imperative for patients suffering from recurrent trigeminal neuralgia (TN). Despite numerous reports on the use of enhanced percutaneous balloon compression (PBC) techniques, such as altering compression duration and balloon pressure, none have yielded satisfactory outcomes. With these issues in mind, we have employed the PBC double-compression technique for the first time. This technique involves initially inflating a balloon to expand the adhesive tissue in Meckel’s lumen, followed by emptying of the contrast medium and subsequent slight catheter adjustment for further compression. The total duration of compression remains unchanged and may even be shortened. OBJECTIVES: The objective of this study was to assess the clinical effectiveness of the PBC double-compression technique in patients with recurrent TN and to analyze the technique’s efficacy, subsequent duration of patients’ facial numbness, and other complications. STUDY DESIGN: Retrospective study. SETTING: A single-center study. METHODS: Retrospective analysis was conducted on clinical data from 125 patients with postoperative recurrent TN who underwent double compression of the PBC and 65 patients who underwent single compression of the PBC between August 2017 and April 2022. The Barrow Neurological Institute Pain Intensity (BNI-P) score was utilized to quantify the severity of pain, while the Barrow Neurological Institute Facial Numbness (BNI-N) score was employed to separately evaluate the extent of postoperative pain relief and facial numbness. RESULTS: The BNI-P and BNI-N scores before and after PBC treatment are presented herein. At T0, there was no significant difference in the BNI-P scores between the single-compression group and the double-compression group; however, at T1-T4, the BNI-P scores of the double-compression group were lower than those of the single-compression group (P < 0.05). There was no significant difference in BNI-P scores between the 2 groups at T5. At T1-T4, the BNI-N score of the double-compression group was significantly lower than that of the single-compression group (P < 0.05). However, there was no significant difference in BNI-N score between the double and single compression groups at T5. In the single-compression group, one patient (1.5%) experienced insignificant pain relief on postoperative day one, while 2 patients (3.1%) suffered from pain recurrence during the 1-4-year follow-up period. Similarly, in the double-compression group, one patient (0.8%) had inadequate pain relief on postoperative day one, and 3 patients (2.4%) experienced pain recurrence during the same follow-up period. The remaining patients did not require further surgical intervention but continued to rely on regular oral analgesia. In the single-compression group, masticatory muscle weakness was observed in 50 cases (76.9%), while in the double-compression group, it was observed in 92 cases (73.6%). Perioral herpes affected 4 patients (7.1%) and 6 patients (4.8%) in the single- and double-compression groups, respectively. Facial hematoma occurred in 7 cases (10.8%) and 13 cases (10.4%) of the single- and double-compression groups, respectively; each group included one patient suffered who from diplopia. Notably, none of the patients in this study reported any instances of corneal anesthesia, anesthesia pain, aseptic meningitis, cerebrospinal fluid leakage, subarachnoid hemorrhage, carotid-cavernous fistula, or mortality. LIMITATIONS: This was a single-center retrospective study with a small sample size and relatively short follow-up time. Therefore, further evaluation of the long-term efficacy of PBC for postoperative recurrent TN is needed from multiple centers with larger sample sizes and longer follow-up periods. CONCLUSIONS: The double PBC method boasts a high cure rate, a low recurrence rate, and minimal complications, rendering the option appropriate for patients with recurrent TN and thus deserving of clinical promotion. KEY WORDS: Percutaneous balloon compression, recurrent trigeminal neuralgia, double-compression method

Safety and Efficacy of Radiofrequency Ablation of Gasserian Ganglion in Trigeminal Neuralgia

Background: Trigeminal neuralgia (TN) is characterized by intractable pain in one or more division of trigeminal nerve. Pharmacologic management is first line treatment for TN, when it fails interventional treatment options are considered like percutaneous procedures or micro vascular decompression. Radio frequency thermoscoagulation is an effective option for medically refractory cases to control pain.Objective: To evaluate the safety and efficacy of Radiofrequency thermocoagulation of the gasserian ganglion for the treatment of trigeminal neuralgia.Methods: Total 44 patients were included in this prospective obsarvational study who were already diagnosed with trigeminal neuralgia and refractory to medical management. All patients were treated by radiofrequency thermocoagulation after confirming the position of needle tip by sensory and motor stimuli. Three lesions were created at 60-70oC for 90 second each. Patients were assessed for pain relief, corneal reflex, numbness and masticatory muscle weakness at immediate post procedural stage, 1 week, 1 month and at 6 months.Results: Twenty eight patients had pain over both mandibular (V3) and maxillary (V2) division, 12 patients had mandibular (V3) and 4 patients had only maxillary (V2) division involvement. Excellent pain relief was archived in 38 (86.36%) patients, 4 patients (9.09%) have good pain control and 2 (4.54%) patient developed poor pain control with development of Anesthesia dolorosa in 1 patient. None of them develop complete facial numbness, 41 patients developed tolerable numbness and 2 patients develop somewhat bothersome, Facial numbness. Three patients developed unilateral masseter muscle weakness however no patients developed corneal ulcers, blindness or other complications.Conclusion: Temperature controlled thermocoagulation is a safe and effective treatment options for trigeminal neuralgia.

Comparison of percutaneous balloon compression and microvascular decompression in the treatment of trigeminal neuralgia.

To compare the effect of percutaneous balloon compression (PBC) and microvascular decompression (MVD) in the treatment of trigeminal neuralgia (TN). Data of 98 patients with TN, admitted to Chenzhou First People's Hospital from May 2020 to May 2022, were retrospectively collected. Patients were divided into two groups based on the surgical method. A total of 53 patients treated with PBC comprised the PBC-group and 45 patients treated with MVD comprised the MVD-group. The immediate pain relief, long-term efficacy, surgical complications, and masticatory muscle strength of the two groups were compared and analyzed. There was no significant difference in the immediate pain relief and long-term e efficacy, between the two groups (P>0.05). Complication rate in the PBC-group was significantly lower than that in the MVD-group (3.77% vs 17.78%, P<0.05). Medical records within 14 days after the operation showed that the incidence of facial numbness and masticatory muscle weakness in the PBC-group were 37.74% and 28.30% respectively, significantly higher than those in MVD-group (4.44% and 2.22%) (P<0.05). These symptoms gradually improved three months after the surgery, and were almost completely resolved after six months. Compared with MVD, PBC has the same effect in the treatment of TN. PBC is a minimally invasive, safe, and effective method with a low complication rate. Although masticatory muscle strength is slightly impacted by PBC, it gradually recovers within six months after the operation.

Percutaneous balloon compression of trigeminal ganglion under conscious sedation local anesthesia for the treatment of primary trigeminal neuralgia-A prospective cohort study.

Trigeminal neuralgia is a debilitating condition that can significantly impair the quality of life of affected individuals. Percutaneous balloon compression (PBC) has been established as an effective treatment for this condition. However, the use of general anesthesia during the procedure poses challenges to achieving the desired degree of nerve damage without causing excessive numbness. In this study, we aimed to evaluate the feasibility and efficacy of performing PBC under conscious sedation of local anesthesia. We improved the surgical procedure for PBC by administering intraganglionic lidocaine 0.2% with fine needle aspiration to achieve conscious sedation. This allowed the operator to determine the degree of nerve damage in real time through the tactile test. We conducted a clinical observation of 87 patients who underwent PBC under conscious sedation of local anesthesia. We evaluated the intraoperative blood pressure and heart rate changes, postoperative facial pain relief, and occurrence of complications such as severe facial numbness, irreversible keratitis, vision loss, and masticatory muscle weakness. All 87 patients achieved immediate relief of facial pain after undergoing PBC under conscious sedation of local anesthesia. The intraoperative blood pressure and heart rate changes were <20% of the baseline value. No patient experienced severe facial numbness or developed irreversible keratitis, vision loss, or masticatory muscle weakness. Our findings suggest that PBC under wide-awake local anesthesia is a safe and effective treatment for trigeminal neuralgia. The use of conscious sedation of local anesthesia during the procedure allows the operator to achieve the desired degree of nerve damage without causing excessive numbness. This can lead to long-term pain relief and improved quality of life for patients with trigeminal neuralgia.

A retrospective study to examine the association of different pear-shaped balloons with efficacy and postoperative complications in percutaneous balloon compression for trigeminal neuralgia.

Percutaneous balloon compression is a safe and effective therapeutic modality for trigeminal neuralgia. It is widely recognized that the pear-shaped balloon is the key to the success of the procedure. This study aimed to analyze the effect of different pear-shaped balloons on the duration of the treatment outcome. In addition, the relationship between individual variables and the duration and severity of complications was analyzed. The clinical data and intraoperative radiographs of 132 patients with trigeminal neuralgia were reviewed. We classify pear-shaped balloons into type A, type B, and type C balloons depending on the size of their heads. The collected variables were correlated with prognosis by univariate and multivariate analyses. The efficiency of the procedure was 96.9%. There was no significant difference in pain relief rates between the different pear-shaped balloons. Median pain-free survival time was longer for type B and C balloons, which were significantly different from type A balloons. In addition, pain duration also was a risk factor for recurrence. There was no significant difference in the duration of numbness between the different types of pear-shaped balloons, but type C balloons resulted in longer-lasting masticatory muscle weakness. Duration of compression and balloon shape can also significantly influence the severity of complications. Different pear-shaped balloons have been shown to have a significant effect on the efficacy and complications of the PBC procedure, with type B balloons (head ratio: 10-20%) appearing to be the ideal pear shape. However, its clinical application remains to be validated.

Dysphagia severity is associated with worse sleep-disordered breathing in infants with Down syndrome.

Hypotonia, commonly seen in infants with Down syndrome (I-DS), can contribute to masticatory and oropharyngeal muscle weakness, increasing the risk for dysphagia and sleep-disordered breathing. Data describing the occurrence of dysphagia and sleep-disordered breathing in I-DS are limited. This study aims to determine the frequency and severity of dysphagia and its relationship to polysomnogram parameters in I-DS. We included I-DS who underwent polysomnography at a single academic center over a 6-year period. Data collected included sex, age, presence of dysphagia (low suspicion of dysphagia vs dysphagia vs feeding tube), and polysomnographic data. Dysphagia was determined by a video fluoroscopic swallow study in the presence of clinical suspicion. A total of 40 I-DS were identified (mean age 6.6 months ± 3; male 65%). There were 11, 13, and 16 I-DS with low suspicion of dysphagia, dysphagia, and feeding tube, respectively. Obstructive sleep apnea was more severe in I-DS in the feeding tube group when compared with the group with a low suspicion of dysphagia and (apnea-hypopnea index mean [standard error] = 49.3 [7.6] vs 19.2 [9.2] events/h; P = .016). Dysphagia severity was positively correlated with a higher obstructive apnea-hypopnea index (r = .43, P = .006). There is a high incidence of dysphagia and sleep-disordered breathing in I-DS. Dysphagia severity correlated with obstructive apnea-hypopnea index severity. Our results suggest that I-DS need early evaluation of both sleep-disordered breathing and dysphagia. Cho Y, Kwon Y, DelRosso L, Sobremonte-King M. Dysphagia severity is associated with worse sleep-disordered breathing in infants with Down syndrome. J Clin Sleep Med. 2023;19(5):883-887.

Clinical study on the treatment of primary trigeminal neuralgia by robot-assisted percutaneous balloon compression.

C-arm-guided percutaneous puncture balloon compression alone has risk factors of puncture failure, complications, and poor prognosis. Robot-assisted PBC can effectively increase the one-time puncture success rate and improve the safety of the procedure. However, evidence on the superiority of robot-assisted PBC over C-arm-guided PBC alone remains relatively limited. Retrospective analysis The clinical data of 60 patients with trigeminal neuralgia aged 60 years or older in the Department of Neurosurgery of the Fourth Hospital of Harbin Medical University from January 2021 to October 2021. There were 29 males and 31 females, and the patients' ages ranged from 60 to 79 years, with an average of 71.63 ± 5.12 years. Two groups were divided according to the surgical method, the C-arm guidance-only group (30 cases, n = 30) and the robot-assisted group (30 cases, n = 30). The success rate of first puncture, total operation time, number of "pear-shaped" balloons, number of C-arm x-ray scans, and immediate postoperative relief rate were recorded in both groups, and follow-up was performed to evaluate the postoperative results and complications. The overall evaluation of postoperative results and complications was performed. Intraoperative balloon compression was successfully completed in all 60 patients, and the first puncture success rate was higher in the robot-assisted group than in the simple C-arm group, with a significant difference between the two groups (P < 0.001). In terms of intraoperative balloon morphology, the number of "pear-shaped" balloons was higher in the PBC than in the C-arm-only PBC group, with a significant difference between the two groups (P < 0.005). The degree of immediate postoperative remission in the robotic group was 0 VAS score, which was not statistically significant in both groups (P > 0.05). By the final follow-up, the mean VAS score of the robot-assisted group was lower than that of the simple C-arm group, and both were statistically significant (P < 0.05); complications of masticatory muscle weakness or abnormal facial sensation occurred in both groups after surgery, but the number of cases in the robot-assisted group was less than that of the simple C-arm group. Robot-assisted PBC is better than PBC with a C-arm x-ray machine in terms of first puncture success rate, number of intraoperative balloon "pear-shaped" cases, number of C-arm x-ray scans and short-term efficacy.

0534 Dysphagia Severity is Associated with Worse Sleep Disordered Breathing in Infants with Trisomy 21

Abstract Introduction Hypotonia is common in infants with Trisomy 21. This can cause masticatory and oropharyngeal muscle weakness increasing the risk for dysphagia and sleep disordered breathing. Data describing the occurrence of dysphagia and sleep disordered breathing in infants with Trisomy 21 is limited. This study aims to determine the frequency and severity of dysphagia and its relationship to polysomnogram parameters in infants with Trisomy 21. Methods Retrospective chart review of patients with Trisomy 21 &amp;lt;12 months old that underwent polysomnography at Seattle Children’s Hospital between October 1, 2015-August 23, 2021. Data collected included: sex, age, presence of dysphagia, recommended thickener type and polysomnographic data. Results A total of 526 polysomnograms in patients with Trisomy 21 were performed. Forty-one studies were identified in &amp;lt;12 months old. Results in mean ± SD showed: age 6.5 months + 3, 66% were male and 73% were diagnosed with dysphagia through a video fluoroscopic swallow study. In those with dysphagia, 16% can tolerate thin liquids, 20% prescribed nectar-thick, 7% prescribed honey-thick and 57% were G-tube dependent. In patients with dysphagia compared to those without dysphagia: there was higher total AHI of 43.3 +/- 35.3 vs. 22.6 +/- 10.6 (p=0.006), oAHI of 39.7 +/- 35.5 vs. 17.2 +/- 11.6 (p=0.004), CAI of 3.4 +/- 3.4 vs. 3.4 +/- 1.8 (p=0.11), oxygen saturation nadir of 78.6 +/- 10.6 vs. 83.1 +/- 6.6 (p=0.11) and percentage total sleep time TcCO2 &amp;gt;50 mmHg of 44.6 +/- 42.6 vs. 31 +/- 40.3 (p=0.44). Worse dysphagia was positively correlated with a higher oAHI (r=0.38, p=0.03). Conclusion There is a high incidence of dysphagia and sleep disordered breathing in infants with Trisomy 21. Dysphagia severity correlated with oAHI severity. Dysphagia in OSA can be due to the sensory and motor changes of the pharynx with impaired swallow-breathing mechanism. Chronic microaspiration can also result in decreased pulmonary reserve from lower airway inflammation or lung parenchymal disease, which may lead to worse sleep disordered breathing. Current guidelines suggest screening at school age or when there are clinical symptoms of OSA in Trisomy 21. However, results suggest the need to evaluate and intervene earlier especially in infants with dysphagia. Support (If Any)

Factors that may affect recurrence of trigeminal neuralgia after percutaneous balloon compression

ObjectiveTo investigate the efficacy of percutaneous balloon compression of the Gasserian Ganglion (PCGG) in the treatment of trigeminal neuralgia(TN)and the influencing factors of recurrence after PCGG. MethodsThe clinical data of 221 patients with TN treated by PCGG were retrospectively analyzed and followed-up to explore the postoperative efficacy. ResultsThere were 158 cases of immediate disappearance of pain and 59 cases of delayed pain disappearance in patients after one PCGG operation, for an overall efficacy rate of 98.2%. Forty-nine patients experienced recurrence of pain, for a recurrence rate of 22.6%, and average recurrence time of 18 months. The effective rate of medication in patients with recurrent trigeminal neuralgia is 85.7%.Univariate and multivariate logistic regression analyses showed that hypertension disease and delayed pain disappearance were independent factors for recurrence. The incidence of inhibitory reaction of the trigeminal nerve during the operation was 97.3%. The most common postoperative complications were facial numbness, masticatory-muscle weakness, tinnitus, diplopia and keratitis, which occurred at rates of 76.9%, 28.1%, 14.5%, 11.8% and 10.4%, respectively. All of the complications resolved within 3 years after PCGG. ConclusionsPCGG is a safe and effective surgical method for the treatment of TN. The pain in most patients disappeared after surgery, leaving sequelae such as facial numbness, masticatory-muscle weakness and tinnitus. The mean time to recurrence of postoperative pain was 18 months, with hypertension disease and delayed pain disappearance as associated factors.

A Simple Method for Foramen Ovale Puncture Based on Preoperative Image Simulation in Percutaneous Microcompression of the Trigeminal Ganglion.

The classic puncture method of percutaneous microcompression using fluoroscopy might be difficult to precisely locate and visualize the foramen ovale. Various new surgical tools to increase the accuracy of finding the foramen ovale location have been introduced. However, all of these systems require some complicated operating steps and/or advanced devices to complete the work. To describe the use of a simple method for foramen ovale puncture by percutaneous microcompression based on preoperative image simulation. Forty-five patients were included in the study. All patients underwent a computed tomography examination. Among them, the simulated preoperative puncture pathway was reconstructed on the basis of computed tomography scan examination for 22 patients. Procedures were performed by 2 surgeons: one experienced surgeon and another young surgeon with surgical qualification. The puncturing time and cumulative radiation exposure dose, from start of the puncturing until reaching the foramen ovale, were recorded. Postoperative pain relief, facial hypoesthesia, masticatory muscle weakness, and other complications were recorded. In all cases, the procedure of cannulation was completed successfully. The puncturing time for both the experienced and young surgeon with the use of preoperative image simulation seemed to be time-saving. The young surgeon had less cumulative radiation exposure with the use of preoperative image simulation. Moreover, the intraoperative puncture pathways were almost consistent with the preoperative simulated images. The rest of the process went smoothly. Short-term outcomes of all the 45 patients were satisfactory. Based on our preliminary experience, the preoperative image simulation-guided technique is useful during these cases.

Association between Temporomandibular Disorder and Masticatory Muscle Weakness: A Case report

Association between Temporomandibular Disorder and Masticatory Muscle Weakness: A Case report

The Long-Term Clinical Outcomes of Selectively Extracranial Radiofrequency Thermocoagulation for Trigeminal Neuralgia Guided by Three-Dimensionally Printed Personalized Template

Abstract: The purpose of this study was to assess the long-term pain relief and the complications of selectively extracranial radio-frequency thermocoagulation (RFT) for trigeminal neuralgia (TN) guided by a three-dimensionally (3D) printed personalized template. The authors conducted a retrospective study of 117 TN patients, who were treated with selectively extracranial RFT under 3D printed personalized template guidance between September 2014 and January 2019. The mean follow-up duration was 42.8 months (range: 28–83 months). Favorable pain relief of patients was 100% at discharge, 86.3% at 1 year, 80.3% at 2 years, 78.6% at 3 years, and 75.4% at 5 years. No complication associated with a puncture or intracranial complication was observed during or after RFT. Postoperative complications included facial numbness in 91 patients (77.8%), masticatory muscle weakness in 15 patients (12.8%), ear paresthesia in 3 patients (2.6%), limited mouth opening in 2 patients (1.7%), and taste hypesthesia in 2 patients (1.7%). Most of these symptoms were improved during the visits and their life was not severely affected. Selectively extracranial RFT guided by a 3D printed personalized template is a clinically practical, effective, and safe approach for TN patients.

Мyasthenia gravis complicated by comorbid pathology

Acquired myasthenia gravis is a rare pathology of the spectrum of neuromuscular disorders and is characterized by the production of autoantibodies to various components of the neuromuscular synapse. The clinical picture is based on typical symptoms: dynamic ptosis, oculomotor dysfunction, diplopia, masticatory muscle weakness, pathological muscle fatigue, in case of dominance of oropharyngeal muscle weakness, patients complain of dysphagia, dysarthria, dyspnea resulting from insolvency.. This variant of the disease is the most dangerous, as it is characterized by a high risk of myasthenic crisis. In addition, the course of myasthenia gravis may be complicated by the development of comorbid pathology, which can be classified into four main groups. These include causal conditions in the development of diseases with a single mechanism of development for myasthenia gravis, such as cross‑autoimmune damage to the heart muscle. The group of complications of myasthenia includes myasthenic, cholinergic and mixed crises. Unrelated diseases are competitive, so in the elderly, myasthenia gravis is accompanied by a wide range of chronic diseases, such as hypertension, diabetes and others. The last group that should be targeted is intercurrent diseases — acute pathologies that develop against the background of myasthenia. Infectious diseases involving the most vulnerable respiratory system are potentially dangerous in the latter group. Knowledge of these potential factors of decompensation of myasthenia gravis will predict the development and timely diagnose the pathology. Timely treatment in a life‑threatening condition can be critical, since myasthenia gravis differs significantly from other diseases of the neuromuscular system in the rate of critical decompensation and the difficulty of normalizing the patient’s severe condition.

Frequent and Persistent Salivary Gland Ectasia and Oral Disease After COVID-19

The clinical picture of coronavirus disease 2019 (COVID-19) in various target organs has been extensively studied and described. However, relatively little is known about the characteristics of oral cavity involvement. This is surprising, considering that oral mucosal and salivary gland cells are known targets for the direct replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and that the presence of the virus in saliva is a source of transmission of the infection. The aim of our study was to investigate the presence and prevalence of oral manifestations in COVID-19 survivors. We profiled the oral involvement in 122 COVID-19 survivors that were hospitalized and followed up at a single-referral university hospital in Milan, Italy, between July 23, 2020 and September 7, 2020, after a median (interquartile range) time from hospital discharge of 104 (95 to 132) d. We found that oral manifestations, specifically salivary gland ectasia, were unexpectedly common, with oral manifestations being detected in 83.9% while salivary gland ectasia in 43% of COVID-19 survivors. Salivary gland ectasia reflected the hyperinflammatory response to SARS-CoV-2, as demonstrated by the significant relationship with C-reactive protein (CRP) and lactate dehydrogenase (LDH) levels at hospital admission, and with the use of antibiotics during acute disease. Both LDH levels and antibiotic administration survived as independent predictors of salivary gland ectasia at multivariable analysis. Temporomandibular joint abnormalities, facial pain, and masticatory muscle weakness were also common. Overall, this retrospective and prospective cohort study of COVID-19 survivors revealed that residual damage of the oral cavity persists in the vast majority of patients far beyond clinical recovery, and suggests that the oral cavity represents a preferential target for SARS-CoV-2 infection. Further studies are needed to clarify the connection between SARS-CoV-2 infection and oral disorders.

Brain activity assessment by functional MRI before and after radiofrequency of gasserian ganglia in patients with trigeminal neuralgia

Background and Objectives: Trigeminal neuralgia (TN) is one of the common causes of facial pain. However, its treatment is a challenge. Radiofrequency (RF) is an effective and safe option that is available. In our study, we used functional Magnetic resonance imaging (fMRI) to assess levels of brain activity in patients with TN, before and after receiving radiofrequency.&#x0D; Methodology: This study is a randomized prospective clinical study. It included 30 patients with TN who were scheduled for thermal (i.e. conventional) radiofrequency (CRF) and pulsed radiofrequency (PRF). 15 patients were randomly assigned to each group. All patients were contacted before the intervention and then 1 week, 1 month, 3 months, and 6 months after the intervention. They were assessed using the Visual Analogue Scale (VAS) score, and their complaints of facial numbness, muscles of mastication dysfunction and carbamazepine dose. fMRI was done before and one month after the intervention.&#x0D; Results: The study group comprised of 13 men and 17 women; a total of 30 patients. The mean age of patients was 50.60 ±12.06 years in the thermal radiofrequency group and 47.93 ±9.90 years in the pulsed radiofrequency group. The median VAS score before the procedure was 8 in both groups, (7-9) in CRF and (7-8) in PRF. Our study demonstrated a statistically significant difference in VAS score at different stages of follow-up after thermal radiofrequency and pulsed radiofrequency when compared with the pretreatment stage. PRF patients continued on medications. Mild complications as facial numbness and masticatory muscle weakness were reported in the CRF group. In some brain regions, fMRI revealed reduced BOLD signal activation after radiofrequency ablation compared to that before the radiofrequency therapy but it was not significant.&#x0D; Conclusion: In our study, post-intervention fMRI revealed a reduction in signal activations of some brain regions but we could not correlate these changes with the clinical improvement. Radiofrequency is an effective treatment for trigeminal neuralgia. CRF is preferable as it had less complications.&#x0D; Key words: fMRI; Trigeminal neuralgia; Pulsed Radiofrequency; Thermal radiofrequency&#x0D; Citation: Abdallah M, Khalil S, Hamed A, Soliman RK, Mohamed A. Brain activity assessment by functional MRI before and after radiofrequency of gasserian ganglia in patients with trigeminal neuralgia. Anaesth. pain intensive care 2020;24(6):---&#x0D; Received: 30 July 2020, Reviewed: 6 October 2020, Revised: 29 October 2020, Accepted: 30 October 2020&#x0D; Abbreviations: fMRI – functional Magnetic Resonance Imaging, RF – Radiofrequency, CRF – Conventional Radiofrequency, PRF – Pulsed Radiofrequency, TN – Trigeminal Neuralgia, BMI – Body mass index, VAS – Visual Analogue Scale, BOLD – Blood Oxygen Level-Dependent, ReHo – Regional Homogeneity, ALFF – Amplitude of Low Frequency fluctuations.

Efficacy of and risk factors for percutaneous balloon compression for trigeminal neuralgia in elderly patients

Objective To investigate the efficacy and safety of percutaneous balloon compression (PBC) for the treatment of trigeminal neuralgia in elderly patients. Methods: We retrospectively analysed data of 105 elderly patients with primary trigeminal neuralgia who were over 70 years and underwent percutaneous balloon compression using anatomic positioning and imaging guidance from January 2019 to November 2019. Results: The immediate cure rate of pain in this group of patients was 97.1% (Barrow Neurological Institute (BNI) pain scores: class I and II; numbness score: class II). Postoperative keratitis was reported in 1 patient, masticatory muscle weakness and muscle atrophy in 1 patient, herpes labialis in 8 patients and lacunar infarction in 2 patients. Facial numbness and decreased sensation occurred in patients with significant pain relief. No serious complications were reported. There was no statistically significant difference in efficacy between the short compression and long compression time groups. Conclusion: PBC is a safe and effective approach to treat trigeminal neuralgia.

Outcomes of Treatment for Elderly Patients With Trigeminal Neuralgia: Percutaneous Balloon Compression Versus Microvascular Decompression.

The study aimed to evaluate the surgical outcomes of percutaneous balloon compression (PBC) and microvascular decompression (MVD) in the treatment of elderly patients with trigeminal neuralgia (TN). A total of 30 patients who underwent PBC surgery (PBC group) and 30 patients who received MVD surgery (MVD group) were included. The treatment efficacy, Barrow Neurological Institute (BNI) pain intensity score, inflammatory response, the rates of complication and recurrence were analyzed respectively. The total efficacy was 93.33% in the PBC group and 90.00% in the MVD group (P > 0.05), respectively. The pain relief rate was 90.00% and 86.67% after PBC and MVD surgery, respectively (P > 0.05). The levels of IL-1β, TNF-α, and IL-6 were significantly decreased at post-operative 3 days and 5 days compared with pre-operation in the 2 groups (P < 0.05). The post-operative complication rates regarding masticatory muscle weakness and facial numbness in the PBC group were higher than MVD group (P < 0.05). Nevertheless, the incidences of herpes simplex and keratohelcosis were similar between the 2 groups (P > 0.05). The recurrence rates were also similar between the 3 groups (P > 0.05). Percutaneous balloon compression and MVD are effective in the treatment for elderly TN, which can effectively improve the post-operative cure rate of pain prognosis and reduce the inflammatory response. However, PBC is a minimally invasive, safe and effective method for patients in poor general condition and refused treatment with craniotomy.

McArdle Disease: Clinical, Biochemical, Histological and Molecular Genetic Analysis of 60 Patients.

A clinical, biochemical, histological and molecular genetic analysis of 60 McArdle patients (33 males and 27 females; mean age at diagnosis: 37 years) was performed. The objective of this study was to identify a possible genotype–phenotype correlation in McArdle disease. All patients complained of exercise-induced myalgia and fatigue; permanent weakness was present in 47% of the patients. Five percent of patients conveyed of masticatory muscle weakness. Age of onset was <15 years in 92% patients. Serum creatine kinase was elevated 5 to13-fold. Forearm ischemic test showed decreased lactate production but excessively increased ammonia upon exercise (n = 16). Muscle biopsies revealed highly reduced or missing myophosphorylase activity (n = 20) (mean: 0.17 ± 0.35 U/g tissue; normal: 12–61) and histologically, sub-sarcolemmal glycogen accumulation (n = 9). Molecular genetic analysis revealed the common p.Arg50Ter mutation in 68% of the patients. Other rather frequent mutations were p.Arg270Ter (allele frequency: 5%) followed by c.2262delA and p.Met1Val (allele frequencies: 3%). Twenty-four other rare mutations were also identified. No genotype–phenotype correlation was observed. The analysis highlights that testing of the p.Arg50Ter mutation could be performed first in molecular genetic testing of patients with exercise intolerance possibly due to McArdle disease. However, there is enormous mutation heterogeneity in McArdle disease thus sequencing of the myophosphorylase gene is needed in patients highly suspicious of McArdle disease.

The Long-Term Outcome of 3-Dimensional CT-Guided Percutaneous Radiofrequency Thermocoagulation for Tumor-Related Trigeminal Neuralgia

Background: Percutaneous radiofrequency thermocoagulation (PRFT) has been widely used to treat trigeminal neuralgia. By querying MEDLINE, EMBASE, and the Cochrane Library, no study has reported the long-term outcome of PRFT for tumor-related trigeminal neuralgia (TRTN). Objectives: In this study, we aimed to evaluate the long-term efficacy and safety of PRFT as an alternative treatment for TRTN. Study Design: A retrospective study. Setting: The interventional pain management center in Beijing Tiantan hospital. Methods: We retrospectively analyzed data of all patients who underwent PRFT applied to the Gasserian ganglion under computed tomography guidance for TRTN through a combination of available institutional electronic medical records, patient notes, and radiologic images. Results: Among 38 patients with PRFT treated between March 2007 and February 2018, 13 patients were men and 25 were women. All patients were evaluated as modified Barrow Neurological Institute (BNI) IV-V before the operation and had a total symptom duration of 45.55 ± 23.31 months. The mean operation duration was 59.63 ± 16.89 minutes. All patients experienced satisfactory pain relief defined as a classification of BNI I-IIIb within 3 days after PRFT. The median remission length with satisfactory pain relief was 33 (range, 4-132) months. No serious intraoperative complications, except bradycardia in 6 patients, were recorded. Postprocedure complications, including masticatory muscle weakness, were reported in 5 patients. Although all 38 patients experienced facial dysesthesia, the patients’ Likert scale rating represented that quality of life significantly increased after the procedure. Limitations: The small sample size may have unavoidably caused selection bias in our study. Larger prospective, randomized, multicenter trials are necessary to validate our outcomes. Conclusions: PRFT is an effective and safe treatment that should be considered as an alternative for pain control in the treatment of TRTN. Key words: Pain, secondary trigeminal neuralgia, radiofrequency thermocoagulation, trigeminal neuralgia

Combination of Pulsed Radiofrequency with Continuous Radiofrequency Thermocoagulation at Low Temperature Improves Efficacy and Safety in V2/V3 Primary Trigeminal Neuralgia

Primary trigeminal neuralgia (TN) is a common clinical refractory neuralgia. Severe pain is experienced during episodes, severely impacting the patient's quality of life. Long-term suffering from the disease can lead to anxiety, depression, and even suicide. The pathological processes involved in TN are complex, the mechanisms of pathogenesis are unknown, and effective treatment is lacking. This study aimed to assess the efficacy and safety of computed tomography (CT)-guided pulsed radiofrequency (PRF) combined with low-temperature continuous radiofrequency (CRF) thermocoagulation in V2/V3 primary trigeminal neuralgia. This research used a retrospective comparative study design. The research took place at Shengjing Hospital of China Medical University. A total of 80 hospitalized patients with TN were selected between January 2014 and December 2015 and randomly assigned to 2 groups differentiated by therapeutic method: CRF (CRF group, n = 40) and PRF + CRF (PCRF group, n = 40). Radiofrequency therapy was performed under the guidance of CT. Follow-up measures assessed preoperative conditions, pain remission, complications and side effects, recovery time, and recurrence rate over the 2 years following the surgery. The Visual Analog Scale (VAS) scores decreased in both groups after surgery. After one month, the decrease in the VAS score in the PCRF group was more apparent, and this difference was maintained for 2 years. The total efficiency rates in the CRF and PCRF groups were 85% and 97.5%, respectively, at 6 months, 1 year, and 2 years post-surgery. The differences in total efficiency rate of pain between the 2 groups at 6 months, 1 year, and 2 years were statistically significant. Recovery times in the PCRF group were shorter than those in the CRF group. Specifically, recovery times for facial numbness in the CRF and PCRF groups were 3.12 ± 1.21 months and 2.23 ± 1.02 months, respectively. Recovery times for masticatory muscle weakness were 4.33 ± 1.54 months and 3.42 ± 0.98 months, respectively. This study is limited by being a retrospective study, and by having a relatively small sample size from a single center. CT-guided PRF combined with low-temperature CRF thermocoagulation for treating V2/V3 primary TN effectively relieves pain, increases late-stage pain remission rate, reduces complications, and reduces the rate of recurrence. Complication, continuous radiofrequency thermocoagulation, pulsed radiofrequency, recurrence rate, trigeminal neuralgia, Visual Analog Scale.