Radiofrequency Thermocoagulation Research Articles

Hypothalamic Hamartomas: A Narrative Review

Hypothalamic hamartomas (HH) are infrequent, non-neoplastic malformations of the hypothalamus with heterogeneous clinical features, with symptoms including gelastic seizures, central precocious puberty, and cognitive or behavioral deficits. This narrative review synthesizes current knowledge regarding the etiology, clinical manifestations, diagnostic advances, and therapeutic approaches for HH. Genetic insights highlight the role of postzygotic mosaicism and dysregulated Sonic Hedgehog signaling in HH development, emphasizing their relevance in potential therapeutic strategies. Diagnostic modalities such as MRI, PET, and SEEG are pivotal in identifying and characterizing HHs, enabling precise treatment planning. Therapeutic interventions span pharmacological, surgical, and neuromodulatory approaches. While surgical approaches, such as transcallosal resection or stereotactic radiosurgery, can offer considerable seizure control, newer modalities, such as laser interstitial laser thermal therapy (LITT) as well as stereotactic radiofrequency thermocoagulation, prioritize minimizing both cognitive and behavioral sequelae. The use of pharmacologic management and neuromodulation provides adjuvant benefits, specifically in drug-resistant epilepsy; despite progress, limitations still remain, including variability of outcomes and not enough long-term studies. This review underscores the need for multidisciplinary care and advanced research to optimize outcomes and improve the quality of life for patients with HH.

Comparative Efficacy of Surgical Strategies for Drug-resistant Epilepsy: A Systematic Review and Meta-Analysis.

This study evaluated the therapeutic effects of open and minimally invasive surgeries in patients with drug-resistant epilepsy. This study systematically searched electronic databases, including PubMed, Web of Science, Embase, and the Cochrane Library, for randomized controlled trials, subsequent open-label expansion studies, prospective studies and retrospective studies on surgical procedures for patients with drug-resistant epilepsy. The main outcome was seizure-free status. A one-arm meta-analysis integrating data from all studies was performed to evaluate the treatment outcomes at multiple time points. A total of 62 studies were included, representing 5958 individuals who received five treatment regimens. The analysis results indicate that anterior temporal lobectomy and selective amygdalohippocampectomy is still the best choice for treating drug-resistant mesial temporal lobe epilepsy epilepsy in adult epilepsy patients. During the overall follow-up period, the seizure free rates for anterior temporal lobectomy, selective amygdalohippocampectomy, laser interstitial thermal therapy, radiofrequency thermocoagulation, and gamma knife surgery were 62%, 70%, 58%, 47%, and 57%, respectively. Among the five surgical methods included in this study, anterior temporal lobectomy and selective amygdala hippocampal resection seem to have more advantages in postoperative epilepsy control compared to laser interstitial hyperthermia, radiofrequency thermocoagulation, and gamma knife surgery. Each surgical treatment method has its unique focus, and when choosing a specific method, it is necessary to consider the patient's specific situation, the type and location of epileptic seizures, and possible side effects. Treating physician will develop personalized treatment plans based on these factors to maximize treatment effectiveness and reduce risks.

Stereoelectroencephalographic exploration and surgical outcome in Lennox-Gastaut syndrome.

Lennox-Gastaut syndrome (LGS) is typically characterized by drug-resistant epilepsy and subsequent cognitive deterioration. Surgery is a rare but viable option for the control of seizures in a subset of patients with LGS. This study aimed to describe the organization of the epileptogenic zone network (EZN) in patients with LGS using stereoelectroencephalography (SEEG) and to report the outcome of post-SEEG treatment. A quantitative SEEG signal analysis was conducted in 14 consecutive patients with LGS, in whom a potentially localized EZN was suggested based on a comprehensive noninvasive evaluation. The EZN and the irritative zone network were identified using relevant biomarkers during ictal (epileptogenicity index and connectivity epileptogenicity index) and interictal (spikes and high-frequency oscillations) recordings. The applied post-SEEG treatments were assessed, including SEEG-guided radiofrequency thermocoagulation (RF-TC), surgery, and neurostimulation. The seizure onset patterns showed some specificity by seizure type, with 84% of tonic seizures involving low-voltage fast activity. The EZN of patients with LGS was often, but not always, complex and extensive, involving two or more lobes (79%) and both hemispheres (64%). The lateral neocortical structures, particularly the lateral premotor and dorsolateral prefrontal cortices, were identified as being most frequently involved in the EZN. Among the explored subcortical structures, only the pulvinar, central-lateral thalamic nucleus, and hypothalamic hamartoma belonged to the EZN. Twelve patients (86%) underwent SEEG-guided RF-TC, with 50% experiencing a >50% reduction in baseline seizure frequency. Four patients (29%) underwent curative surgery for significant involvement of a lesion in the EZN, and one case achieved an Engel class I outcome. This is the first quantitative SEEG study in patients with LGS to demonstrate the utility of SEEG in identifying patients who may benefit from surgery and to perform SEEG-guided RF-TC. Nevertheless, the indications for SEEG should be carefully assessed, as localized EZN is uncommon in LGS.

The impact of radiofrequency thermocoagulation on brain connectivity in drug-resistant epilepsy: Insights from stereo-electroencephalography and cortico-cortical evoked potentials.

To investigate whether local lesions created by stereo-electroencephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC) affect distant brain connectivity and excitability in patients with focal, drug-resistant epilepsy (DRE). Ten patients with focal DRE underwent SEEG implantation and subsequently 1 Hz bipolar repetitive electrical stimulation (RES) for 30 s before and after RFTC. Root mean square (RMS) of cortico-cortical evoked potentials (CCEPs) was calculated for 15 ms to 300 ms post-stimulation with baseline correction. Contact pairs were categorized as both coagulated, hybrid, or both non-coagulated. The data were divided into nine categories based on the stimulating and recording contact pair combinations. RMS of CCEPs was compared before and after (<12 h) RFTC using a two-sample t test (Hochberg corrected, p < 0.05) for each patient. Boost score, indicating power increase during seizures before RFTC relative to baseline, was analyzed in 4 s windows with 1 s overlap during seizure duration. RFTC altered connectivity across all categories. Of interest, decreases and increases in RMS were observed in connections between non-coagulated contacts distant from coagulation site (range: 1.09-85 mm, median = 17.7 mm, interquartile range [IQR] 10.1-32.3). Contact pairs involved in significantly altered non-coagulated connections showed a higher boost score correlation in the theta, beta, and gamma bands, as well as a stronger maximum correlation with coagulated sites in the delta band than contacts for which connectivity did not change after RFTC. This study highlights how local lesions alter distant brain connectivity, providing insights for future research on epilepsy network changes and seizure outcomes following RFTC.

Detection of epileptogenic zones in people with epilepsy using optimized EEG-fMRI.

Concurrent electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) have been used to assist in the presurgical localization of seizure foci in people with epilepsy. Our study aimed to examine the clinical feasibility of an optimized concurrent EEG-fMRI protocol. The optimized protocol employed a fast-fMRI sequence (sampling rate=10Hz) with a spare arrangement, which allowed a time window of 1.9s for EEG recording without radio frequency noise. Patients with a diagnosis of drug-resistant epilepsy who were candidates for surgical intervention were enrolled and underwent concurrent EEG-fMRI studies to map fMRI blood oxygen level-dependent (BOLD) signal changes related to interictal epileptiform discharges. The BOLD signals were compared to those in the epileptogenic zone determined by resective cavities or radiofrequency thermocoagulation lesions. Postoperative seizure outcomes were classified according to the ILAE classification. The EEG-related BOLD results indicated that 15 of the 19 patients (78.9%) had concordant findings in the epileptogenic zone determined by surgical intervention. The percentage of patients who achieved good surgical outcomes was significantly greater in the concordant group than in the discordant group (n=9, 60.0% vs. n=0, 0%, p=0.033). Using fast MRI scan, the optimized protocol provides satisfactory accuracy (78.9%) for detecting epileptogenic zones. A concordant BOLD signal and epileptogenic zone can predict good surgical outcomes.

Lateralizing value of interictal epileptiform discharges and other parameters in hypothalamic hamartoma.

Hypothalamic hamartomas (HHs) are associated with pharmacoresistant epilepsy. Stereotactic radiofrequency thermocoagulation (SRT) shows promise as a disconnecting intervention. Although magnetic resonance imaging (MRI) is typically used to determine the attachment and intervention side, it presents challenges in cases of bilaterally attached HH, where the epileptogenic side is unclear. The lateralizing potential of electroclinical parameters in such cases remains uncertain. This retrospective study evaluates the lateralization value of specific parameters, particularly in patients with unilateral HH, to improve future diagnostics and treatment approaches for bilateral HH. Four lateralizing parameters-semiology, ictal electroencephalography (EEG), and interictal epileptiform discharges during awake (IEDsw) and sleep states (IEDss)-were assessed for correlation with HH attachment side using Spearman's ρ. We calculated areas under the curves (AUCs) and cutoffs for left and right IEDs prognostic lateralizing value, plotting differences between IEDsright and IEDsleft in a receiver-operating characteristic(ROC) curve to establish the required preponderance of unilateral IEDss to differentiate between left and right HHs. Binomial logistic regression was employed to predict the HH attachment side. We included 25 patients (2-55 years of age) with mainly unilateral (n = 22) HHs who underwent SRT and presurgical evaluation. All parameters correlated with HH attachment side (semiology R = -.62, p = .005; ictal EEG R = .51, p = .047; IEDs R = .55, p = .018; IEDw, R = .61, p = .018). AUC values for right and left IEDs were .76 (p = .047) and .85 (p = .019), respectively, with cutoffs of .34 and .15. The AUC for "IEDsright-IEDsleft" was .98 (p = .0018) with a cutoff of .16. IEDss and semiology were significant predictors, achieving 88% correct lateralization. IEDss are promising biomarkers for HH lateralization in unilateral HH. The predominance of unilateral IEDss suggests ipsilateral HH. Even in cases with predominantly bilateral IEDss, a slight preponderance of unilateral IEDss can indicate the attachment side. In addition, combining IEDss and semiology provides a predictive model for HH lateralization.

Radiofrequency thermocoagulation of Gasserian ganglion in trigeminal neuralgia

Radiofrequency thermocoagulation of Gasserian ganglion in trigeminal neuralgia

Radiofrequency-thermocoagulation in pediatric epilepsy surgery: A systematic review and pooled analysis of cases.

To conduct a systematic review on radiofrequency thermocoagulation (RF-TC) in pediatric epilepsy surgery. In addition, due to the low number of dedicated pediatric series, to conduct a pooled analysis of cases published in the literature. We conducted a literature search using PUBMED and EMBASE which produced 432 results. We excluded studies on hypothalamic hamartomas and non-RF-TC procedures such as stereotactic radiosurgery and laser interstitial thermal ablation. Stereotactic RF-TC and SEEG-guided RF-TC procedures were included. Case series and case reports with individualized data were further reviewed and pediatric cases were extracted for pooled analysis. Patient demographics, electroclinical and neuroimaging data, procedure outcomes, responder rates and complications were collected. Our unpublished experience in pediatric SEEG-guided RF-TC was included in the pooled analysis. We identified 33 articles for the literature review, 24 of them were selected for pooled analysis (93 cases). Sixty patients underwent SEEG-guided RF-TC. For adult and pediatric mixed series reported a 67% responder rate and 32% seizure freedom at 1 year. For exclusively pediatric series, 90% responder rate and 71% Seizure freedom. In the pooled analysis, seizure freedom was achieved in 45.2% and responder rate was 74.2% with a mean follow-up was 25.2 months (SD ± 26.6). Complication rates were low, transient neurological deficits were reported in 18 cases (19.4%) and no deaths were associated with RF-TC. The insula and the dominant frontal lobe were the most frequent targets for ablation. Studies included were highly heterogenous and quality of evidence was low. There are few pediatric studies evaluating RF-TC. Safety and efficacy in children seem to be similar to that reported in larger adult series, although more studies are needed. Most cases reviewed where extracted from heterogeneous adult and pediatric series. Patients with small, high-risk surgical targets are ideal candidates for this procedure.

The short term impact of radiofrequency ablative techniques and peripheral nerve block on thermoregulation in mouse models

This study investigated the impact of multiple nerve block methods (local anesthesia, conventional radiofrequency thermocoagulation [CRF], and pulsed radiofrequency [PRF]) on thermoregulation. Focusing on hypothalamic function, the effects of local anesthesia, CRF, and PRF on central and peripheral temperatures were analyzed and compared. Our findings revealed that all three nerve block groups cause a decrease in central temperature, with the CRF group exhibiting the most pronounced effect. Furthermore, immunostaining analysis showed decreased neural activity in the preoptic area, suggesting that nerve blocks may influence central thermoregulatory mechanisms. This study provides valuable insights into the effects of peripheral nerve blocks on thermoregulation and may contribute to the development of therapeutic strategies to managing perioperative hypothermia and enhancing pain management, especially in patients undergoing surgeries with high risks of thermoregulatory complications, such as on-pump surgery and laparoscopic surgery.

Comparison of radiofrequency thermocoagulation of ganglion Impar with block using a combination of local anaesthetic and steroid in chronic perineal pain

Abstract Background and Aims: Chronic perineal pain (CPP) is the anorectal and perineal pain without underlying organic disease. The prevalence of CPP is 6–18%. The etiology for CPP may be idiopathic, benign, or malignant. We compared radiofrequency thermocoagulation of ganglion Impar with block using a combination of local anaesthetic and steroid for management of chronic perineal pain, with respect to pain relief, patients’ self-reported belief about the efficacy of treatment, and side effects or complications, if any. Material and Methods: Forty patients attending the Pain Management Centre of either sex in the age group of 20–70 years with history, physical examination, and pain patterns consistent with chronic perineal pain, who had been investigated to rule out malignancy and failed to respond to 6 weeks of conservative treatment with a combination of analgesics, anti-inflammatory drugs, neuromodulators, and physiotherapy, were enrolled in the study. The patients were randomly divided into two groups of 20 each using a computer-generated randomization number table. Group-I (n = 20): Patients were administered ganglion Impar block using a drug mixture comprising of 8 ml of 0.25% bupivacaine plus 80 mg of triamcinolone acetate under fluoroscopic guidance. Group II (n = 20): Patients received conventional radiofrequency thermocoagulation of ganglion Impar at 80 degree Celsius for 90 seconds under fluoroscopic guidance. Outcome assessment was done after minimally invasive pain and spine intervention (MIPSI) with evaluation of pain using the Numeric Rating Scale (0–10), patients’ self-reported belief about the efficacy of treatment using Patient Global Impression of Change (PGI-C), and side effects or complications, if any. Results: The majority of the patients in our study were in the age group of 40–50 years, and 80% of the patients were females and weighed 60–70 kg. The majority of the patients in our study had history of trauma, which led to coccygodynia. There was statistically and clinically significant improvement in pain score after ganglion Impar block in both the groups at all time intervals during the study period (P &lt; 0.05). Patients’ self-reported belief about efficacy as per PGI-C was clinically and statistically better in group II as compared to group I at all time intervals throughout the study period (P &lt; 0.005). Four patients in group I required second ganglion Impar block during the 12 months study period. The most common side effect was temporary pain on injection. Conclusions: Both the techniques of MIPSI, that is, fluoroscope-guided ganglion Impar block using corticosteroid and local anaesthetic and radiofrequency thermocoagulation, are effective and provide good pain relief to the symptomatic patients. With respect to improvement in pain relief and patients’ self-reported belief about the efficacy of treatment and side effects or complications, fluoroscope-guided ganglion Impar radiofrequency thermocoagulation is better as compared to fluoroscope-guided ganglion Impar block using corticosteroids and local anesthetics.

Stereoelectroencephalographic thermocoagulation in FLNA-positive heterotopia: Is it an effective treatment?

Periventricular nodular heterotopia (PVNH) is a neuronal migration disorder often associated with drug-resistant epilepsy. The epileptogenic zone network (EZN) in PVNH is generally large, contraindicating surgery. Stereoelectroencephalography (SEEG) can be proposed to map the EZN and perform radiofrequency thermocoagulation (THC) with an efficacy rate of approximately 65%. There are genetic forms of PVNH, particularly with mutations in the filamin A gene (FLNA). However, data on SEEG-guided THC in these patients still have not been described. We report four patients with FLNA-positive PVNH who underwent SEEG-guided THC. All were women with several types of seizures and psychiatric comorbidities. EZN was extensive and often bilateral, including a part of the heterotopias. The outcomes of SEEG-guided THC varied; two patients experienced significant seizure reduction and improvement in psychiatric symptoms (Engel class I-II), one showed partial improvement (Engel class III), and one had no significant benefit (Engel class IV). Psychiatric comorbidities, including posttraumatic stress disorder, depression, and anxiety, were present in all cases, with some patients showing symptom improvement alongside seizure reduction. Despite genetic origin, SEEG-guided THC can be proposed in FLNA-positive PVNH-related epilepsy, although outcomes vary. The presence of FLNA mutations should not contraindicate surgical intervention but may influence the therapeutic response. Further research is needed to understand the impact of genetic variants on epilepsy outcome.

A proposed new classification system of hypothalamic hamartomas in the era of stereotactic ablation surgery.

Since the recent development of stereotactic ablation surgery, which can provide good seizure outcomes without limitations in size or location, conventional classification systems have become unsuitable for surgical guidance. The present study aimed to evaluate the validity of a newly proposed classification system focusing on the attachment pattern. This retrospective study investigated 218 patients with hypothalamic hamartomas who underwent MRI-guided stereotactic radiofrequency thermocoagulation and were followed for at least 1 year after their last surgery. Hypothalamic hamartomas were classified by their attachments into six subtypes: parahypothalamic-unilateral (PU), parahypothalamic-bilateral (PB), intrahypothalamic-unilateral (IU), intrahypothalamic-bilateral (IB), mixed-unilateral (MU), and mixed-bilateral (MB) types. Clinical features, surgical factors, scales of surgical procedures including numbers of trajectories and coagulations, requirement for a trans-third ventricular approach, reoperation rates, and complication rates were investigated. Seizure outcomes were evaluated separately for gelastic seizures (GSs) and non-GSs. In 218 patients (131 [60.1%] males, median age at surgery 7.2 [range 1.8-51] years), the hypothalamic hamartomas were classified as PU type in 10 (4.6%), PB type in 11 (5.0%), IU type in 41 (18.8%), IB type in 17 (7.8%), MU type in 40 (18.3%), and MB type in 99 (45.4%) patients. Patients with MB type were significantly younger at GS onset (p < 0.001) and surgery (p = 0.005). The numbers of trajectories and coagulations were significantly greater in MB type (p < 0.001) and the trans-third ventricular approach was more often required in the PB type (5/6, 83.3%, p < 0.001). Seizure outcomes were not different among subtypes. The rate of transient complications was not different among subtypes, but hyperthermia (p = 0.002) and hyponatremia (p < 0.001) were more frequently found in patients with PB and MB types. Prolonged or persistent neurological complications were also not different and were only found in bilateral subtypes. The new classification predicts clinical features, as well as surgical complexity and complications. Although seizure outcomes were not different among subtypes because the authors' surgical strategy is consistently based on complete disconnection at the border, the new classification could improve seizure outcomes and would be helpful in the appropriate guidance for surgery of hypothalamic hamartomas to provide consistently good outcomes regardless of surgical procedures.

Neuropsychological Outcomes After Stereo-EEG Radiofrequency Thermocoagulation.

Stereo-EEG-guided radiofrequency thermocoagulation (RFTHC) has been proposed as relatively safe from a cognitive perspective; however, there is a lack of evidence based on neuropsychological assessments supporting this. This study is the first prospective evaluation of neuropsychological outcomes associated with stereo-EEG-guided RFTHC in patients with focal drug-resistant epilepsy. This cohort study involved prospective recruitment of consecutive patients undergoing stereo-EEG from 2 Australian centers. A comprehensive neuropsychological assessment was administered before implantation and 3 months after RFTHC (M = 104.51 days, SD = 29.25). Outcomes across cognitive domains were assessed at a group level with repeated measures t tests. Factorial repeated measures analyses of variance compared memory and language outcomes according to whether dominant mesial temporal lobe (mTL) structures were coagulated. Reliable change indices (RCIs) were computed to explore psychometrically reliable changes at an individual level. The sample comprised 39 patients who underwent stereo-EEG (M = 37.08 ± 9.67 years, range = 17-56 years, 54% female). Nineteen (49%) had a language dominant epileptogenic zone (EZ), 16 (41%) a nondominant EZ, and 4 (10%) a bilateral EZ. All patients underwent RFTHC with a mean of 11.87 (SD = 6.82, range = 2-29) coagulation sites. Ten patients (26%) had RFTHC within the dominant mTL. At a group level, RFTHC was not associated with a significant decline on any neuropsychological measures (all comparisons p > 0.05). Subgroup analyses revealed a decline in delayed verbal recall after RFTHC of dominant mTL structures (F(1,37) = 4.46, p = 0.04, ηp2 = 0.11, 95% CI [0-0.30]; medium to large effect), although it did not remain statistically significant after correction for false discovery rate. No statistically significant group differences were observed on visual memory or language measures post-RFTHC (all comparisons p > 0.05). RCI revealed that after RFTHC within the dominant mTL, 20% of patients experienced a decline in verbal memory and 10% in visual memory. By contrast, 7% declined in verbal memory and 10% in visual memory post-RFTHC outside the dominant mTL. While these findings support the current view that RFTHC is cognitively benign for most cases, the results raise the question of a verbal memory decline after coagulation of the dominant mTL. Individualized neuropsychological counseling before stereo-EEG is essential to avoid unanticipated deficits.

Insular Epilepsy: Functions, Diagnostic Approaches, and Surgical Interventions.

Epilepsy, a chronic neurological disorder characterized by recurrent seizures, affects a significant portion of the global population, with drug-resistant epilepsy (DRE) presenting a major treatment challenge. Insular epilepsy, originating from this complex region, exhibits a broad range of symptoms, making diagnosis particularly difficult. Advanced imaging techniques and invasive procedures like stereoelectroencephalography (SEEG) are often crucial for accurately localizing the epileptogenic zone. Surgical resection remains the primary treatment for DRE, with recent advancements in microsurgical techniques and neuroimaging improving outcomes. Additionally, minimally invasive approaches like laser interstitial thermal therapy (LITT) and radiofrequency thermocoagulation (RFTC) offer promising alternatives.

The Impact of Changes in Paraspinal Muscle Tissue on Lumbar Percutaneous Intradiscal Radiofrequency Therapy.

Background/Objectives: This study aimed to assess whether fatty changes in paraspinal muscle tissue negatively affect pain relief and functional outcomes, measured by the Oswestry Disability Index (ODI), in patients undergoing intradiscal bipolar radiofrequency thermocoagulation for lumbar degenerative disc (LDD) disease. Fatty changes in paraspinal muscles, often associated with sarcopenia, are known to negatively influence treatment outcomes. However, there is limited research on how these changes affect pain and functional capacity following intradiscal procedures. Methods: In this study, data from 59 patients treated for LDD were analyzed. Pain severity was measured using the Numerical Rating Scale (NRS), and the ODI was recorded before the procedure and at 1, 3, and 6 months post-procedure. Fatty changes in the paraspinal muscle tissue were evaluated using the Goutallier classification based on pre-procedure T2-weighted MRI scans, while disc degeneration was assessed using the Pfirrmann classification. Results: The results showed significant positive correlations between the Goutallier and Pfirrmann classifications and pain levels at all time points post-procedure (p < 0.05). Notably, the relationship between NRS scores and Goutallier classification was stronger than that with Pfirrmann classification (p < 0.05). ODI scores were also significantly correlated with both Goutallier and Pfirrmann classifications at each time point, with a stronger association observed between ODI and Goutallier classification than with NRS (p < 0.05). Conclusions: These findings suggest that fatty changes in the paraspinal muscle tissue may significantly influence treatment outcomes and should be considered during pre-treatment evaluations. Further research is needed to explore this relationship more comprehensively.

The CT-Imaging Location of Lumbar 3 Sympathetic Radiofrequency Thermocoagulation for Sympathetic-Related Diseases Therapy.

The location characteristic of the lumbar 3 sympathetic trunk under Computed Tomography (CT) was discovered through 106 cases, imaging analysis after successful lumbar 3 sympathetic radiofrequency thermocoagulation operations serving the clinic and reducing the operation time. There are 113 patients underwent bilateral L3 lumbar sympathetic thermal radiofrequency procedures in our hospital from January 2017 to January 2021, with 106 cases of successful procedure. Four operation image distances were measured: 1. The left/right distances between the needle tip (the location of needle tip was the sympathetic trunk at the same CT scan level) and the transverse process of the lumbar spine (D1l/D1r); 2. The left/right distances between the needle tip and the medial margin of the psoas major (D2l/D2r); 3. The left/right vertical distances between the needle tip and vertebral body (D3l/D3r); 4. The left/right vertical distances between ureter and vertebral body (D4l/D4r). The Perfusion Index (PI) and the plantar temperature were monitored and recorded before and after the treatment (the higher PI value and the plantar temperature indicated successful procedure). After the procedure, the patients were followed up one day, one week, two months and six months for satisfaction, complications and recurrences. The left distance (D1l) from the needle tip to the transverse costal process being 4.444±0.7668mm, longer than the right side (D1r, P<0.001). The left distance (D2l) being 1.260±0.4261mm longer than the right side (D2r, P=0.0039). The left distance (D3l) was 1.634±0.2597mm longer than the right side (D3r, P<0.0001). The D4l and D4r both having a long distance far from needle tips (P=0.665). Both the left and right temperature and PI increased have statistical significances after treatment (P<0.0001). There were 2(1.77%) cases experiencing numbness of big thighs, and 9(7.96%) cases of compensatory hyperhidrosis, with only 3 (2.65%) cases reverting to the original state six months later. Lumbar sympathetic radiofrequency thermocoagulation is a valid treatment option for sympathetic-related disease in lower limbs, and based on our study data CT-guided percutaneous puncture lumbar sympathectomy can easy be proceed and gained more persistent effection, the left needle distance more deeper than the right side, the distance from the left side should be far from vertebral body than the right side. The distance between the needle body and the vertebral body on the left side is far away from the right side.

Parameter analysis in stereoelectroencephalography-guided radiofrequency thermocoagulation: A common basis for objective comparison between protocols

ObjectiveStereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) is an invasive procedure based on stereotactic lesioning of cortical targets in the brain using bipolar current through electrode contacts within the SEEG implant. To date, several RF-TC protocols have been described in the literature; however, a consensus has yet to be reached. This work aims to analyze the electrical parameters during RF-TC processes, offering a method to objectively describe and compare different SEEG-guided RF-TC protocols. MethodsThe study included patients who underwent RF-TC procedures at the IRCCS Istituto delle Scienze Neurologiche di Bologna from February 2022 to May 2023. During each procedure, modifications of the following parameters were measured: voltage, current, impedance, and electric power. An ad-hoc algorithm was implemented to detect abrupt impedance raises, which reflects the occurrence of the thermocoagulation. A two-sample t-test was used to compare parameter curves in RF-TC of different brain structures. ResultsA total of ninety-two RF-TC procedures were performed in eight patients according to a standardized protocol. During each procedure, impedance levels started at about 700Ω and rose up to 1300Ω, displaying an erratic pattern characterized by one or multiple raises. All measured parameters exhibited similar trends until the first peak, after which changes were influenced by the frequency of impedance raises. No significant correlations were observed between parameter modifications in distinct anatomical sites of RF-TC. SignificanceThe systematic analysis of electrical parameters may represent a reliable tool to compare different RF-TC protocols, paving the way for identifying optimal configurations for SEEG-guided RF-TC procedures in the future.

Risk factors for poor prognosis in patients with zoster-associated neuralgia who underwent interventional pain management.

Zoster-associated neuralgia (ZAN) is recognized as a challenging neuralgia that often leads to poor prognosis in patients receiving interventional pain management. Identifying risk factors early can enable clinicians to develop personalized treatment plans; however, research in this area is limited. We retrospectively screened all patients with ZAN who received interventional therapy in the Pain Department of Soochow University First Affiliated Hospital from January 1, 2022 to August 31, 2023. Data on patient demographics, medical history, neutrophil-to-lymphocyte ratio (NLR), clinical scoring, and treatment methods were collected. Interventional therapy included short-term nerve electrical stimulation (st-NES), pulsed radiofrequency (PRF) and radiofrequency thermocoagulation (RF-TC). Patients were categorized into poor prognosis and control groups based on outcomes 3 months post-discharge. Multivariate logistic regression was used to identify risk factors for poor prognosis. The final analysis included 282 patients. The rate of poor prognosis was 32.6% (92/282). Multivariate logistic regression analysis revealed that age ≥ 65 years (odds ratio, 2.985; 95% confidence interval, 1.449-6.148; p = 0.003), disease duration >3 months (odds ratio, 3.135; 95% confidence interval, 1.685-5.832; p < 0.001), head and face pain (odds ratio, 3.140; 95% confidence interval, 1.557-6.330; p = 0.001), use of immunosuppressants (odds ratio, 2.737; 95% confidence interval, 1.168-6.416; p = 0.021), higher NLR (odds ratio, 1.454; 95% confidence interval, 1.233-1.715; p < 0.001), PRF (st-NES as reference) (odds ratio, 2.324; 95% confidence interval, 1.116-4.844; p = 0.024) and RF-TC (st-NES as reference) (odds ratio, 5.028; 95% confidence interval, 2.139-11.820; p < 0.001) were found to be independent risk factors for poor prognosis in patients with ZAN who underwent interventional pain management. Age ≥ 65 years (odds ratio, 2.985; 95% confidence interval, 1.449-6.148; p = 0.003), disease duration >3 months (odds ratio, 3.135; 95% confidence interval, 1.685-5.832; p < 0.001), head and face pain (odds ratio, 3.140; 95% confidence interval, 1.557-6.330; p = 0.001), immunosuppressants use (odds ratio, 2.737; 95% confidence interval, 1.168-6.416; p = 0.021), higher NLR (odds ratio, 1.454; 95% confidence interval, 1.233-1.715; p < 0.001), PRF (odds ratio, 2.324; 95% confidence interval, 1.116-4.844; p = 0.024) and RF-TC (odds ratio, 5.028; 95% confidence interval, 2.139-11.820; p < 0.001) were identified as independent risk factors for poor prognosis in patients with ZAN who underwent interventional pain management.

Long-term effects of conventional radiofrequency in cases of trigeminal neuralgia

Objective: Trigeminal neuralgia (TN) is defined as severe, episodic pain occurring in one or more branches of the trigeminal nerve. Due to its long-term effect, radiofrequency thermocoagulation (RFT) is used as a first-line treatment. The first choice in the treatment of classical trigeminal neuralgia patients is medical treatment. Additionally, pregabalin and gabapentin are frequently used drugs. Surgical treatment is an option for Trigeminal Neuralgia that cannot be treated with medication, but there is no single method for this. Various surgical methods, such as Trigeminal Radiofrequency (RF) rhizotomy may be effective in treatment. Material and metods: The procedure is performed under operating room conditions and radiological imaging guidance. The patient is placed in the supine position, an IV line is established, and monitoring is initiated. After local field cleaning and sterile draping, optimal imaging is achieved using C-arm fluoroscopy with an ipsilateral 15° oblique and 30° caudal angle. A 22-gauge, 100 mm RF needle with a 5 mm active tip is directed towards the foramen ovale, and the tunnel view is checked. Results: In our study, the minimum age was 41 and the maximum age was 68. Additionally, 9 of the patients were female, and 2 were male. In our series, 9 patients had mandibular nerve involvement, and 2 had maxillary nerve involvement. In our series, 6 patients were using carbamazepine, 4 were using pregabalin, and 1 was using gabapentin. Medication treatment was discontinued in all patients after the procedure. As shown in Table 1, the VAS score decreased to 0 in 6 patients on the 15th day, to 2 in 4 patients, and to 1 in 1 patient. The VAS score exceeded 5 in 1 patient in the 2nd year and in 5 patients in the 4th year, and conventional RFT was repeated for these patients. The VAS score decreased to 0 in 6 patients on the 15th day, to 2 in 4 patients, and to 1 in 1 patient. The VAS score exceeded 5 in 1 patient in the 2nd year and in 5 patients in the 4th year, and conventional RFT was repeated for these patients. Pregabalin 75 mg was started for all patients between the recurrence of pain and the interventional procedure, and it was discontinued once the pain decreased after the procedure. No side effects were observed in the patients. Conclusion: The treatment of trigeminal neuralgia includes medical, surgical, and percutaneous interventional options. Conventional RF thermocoagulation is the first choice among other percutaneous interventional and surgical treatment options in TN treatment due to its selective lesion formation, minimally invasive nature, high success rate, low complication rate, and low cost.

Comparative evaluation of surgical procedures for trigeminal neuralgia: a literature review

Trigeminal Neuralgia (TN) has been described in the literature as one of the commonest types of craniofacial pain disorders. TN refers to recurrent lancinating pain that occurs in the distribution of one or more branches of the fifth cranial nerve. The pain perception is typically unilateral, abrupt in onset, brief in duration, and usually starts after trivial stimuli. The overall prevalence of TN was reported around 0.7/1000 persons, but it tends to be higher in more advanced age groups since the initial onset of the symptoms most frequently starts at the age of 50–60 years. Although TN is more commonly seen in adults, pediatric TN represents &lt;1.5% of all cases. Pediatric TN differs from adult TN primarily being bilateral in nature (42%) and associated with compression of multiple cranial nerves (46%). This review will evaluate the current surgical procedures used for the treatment of TN. Operative interventions for TN include microvascular decompression (MVD), balloon compression (BC), radiofrequency thermocoagulation (RF TC), glycerol rhizotomy (GR), and stereotactic radiosurgery (SRS). We review the historical development, advantages, and limitations of these operations. Additionally, we compare specific parameters for all current surgical procedures. We evaluated the short- and long-term outcomes, risk factors, complications and side effects in patients with TN who underwent operations. Arguments for and against the use of surgery for TN are presented. Next, surgical decision-making algorithm for refractory classical or idiopathic TN is proposed for patients who require surgery. This algorithm may be used by neurosurgeons in selecting the best surgical treatment. Lastly, we show the data on current clinical trials, the role of genetics to search for genes predisposing to TN. This project begins with the presumption that the risk for developing classical TN is in large part determined genetically. If so, given the power of modern genetic analysis, it should be possible to identify the underlying gene(s). At present, there is no ideal surgical procedure for trigeminal neuralgia—one that is minimally invasive, uniformly effective, lacking complications, and without failures or recurrences. MVD still remains the standard by which all other contemporary procedures are measured. MVD provides the longest pain-free interval, yet it is not free of morbidity and mortality. Stereotactic radiosurgery provides a reasonable noninvasive option, but it has delayed onset and a recurrence interval (a few years).