Volume 103 ·  Issue 07 ·  2023

Neuropathic pain is the pain triggered or caused by primary damage and dysfunction of the nervous system. Its pathogenesis is complex, involving changes in ion channel function, abnormal action potential generation and expansion, and central and peripheral sensitization. Therefore, it has always been the most intractable problem in clinical pain diagnosis and treatment, and there are many kinds of treatment methods. In addition to various oral drugs, nerve block, pulsed radiofrequency, radiofrequency ablation, central nerve electrical stimulation, peripheral nerve electrical stimulation, intra-thecal infusion system, craniotomy nerve decompression or carding, the dorsal root entry zone disfigurement, etc. various methods have mixed efficacy. So far, radiofrequency ablation of peripheral nerves is still the most simple and effective means for the treatment of neuropathic pain. In this paper, the definition, clinical manifestations, pathological mechanism and the treatment methods of radiofrequency ablation of neuropathic pain were expounded, in order to provide reference for related clinicians in radiofrequency ablation.

In recent years, many high-quality studies have been conducted on the pathomechanism and treatment of hypertrophic scar and keloid. This article briefly summarizes the status in these two aspects. Hypertrophic scar and keloid belong to pathological scar, which is characterized by fibrous dysplasia of reticular layer of dermis. This abnormal hyperplasia is due to the chronic inflammatory reaction in the dermis caused by injury. Some risk factors affect the process and outcome of the scar by increasing the intensity and duration of the inflammatory reaction. It is effective to understand the relevant risk factors to conduct patient education and prevent the occurrence of pathological scars. In view of these risk factors, a comprehensive treatment system, including multiple methods, has been established. Recent high-quality clinical research has provided evidence-based medical evidence for these treatments and prevention methods, which has confirmed the effectiveness and safety of the system.

Carpal tunnel syndrome (CTS) is the most common peripheral nerve compression disease. The early diagnosis and treatment are very necessary due to the high incidence rate, diverse hazard factors and the irreversible muscle atrophy caused by the late disease. Clinically, there are many treatments on CTS, both traditional Chinese medicine (TCM) and Western medicine treatment have their advantages and disadvantages. If we can combine them and complement each other, it will be more conducive to the diagnosis and treatment of CTS. Under the support of Professional Committee of Bone and Joint Diseases of the World Federation of Chinese Medicine Societies, in this consensus, we synthesized the opinions of experts in related fields of TCM and Western medicine and formed the recommendations for the diagnosis and treatment of TCM and western medicine of CTS. The consensus also makes a brief CTS diagnosis and treatment flow chart, hoping to provide reference for academic community.

To investigate the efficacy and safety of CT-guided radiofrequency ablation of posterior root of spinal nerve in the treatment of postherpetic neuralgia (PHN).

A total of 102 PHN patients (42 males and 60 females) aged (69.7±9.4) years who underwent CT-guided radiofrequency ablation of posterior root of spinal nerve in the Department of Pain Medicine of the Affiliated Hospital of Jiaxing University from January 2017 to April 2020 were retrospectively included. Patients were followed up, and numerical rating scale (NRS) score, Pittsburgh sleep quality index (PSQI), satisfaction score and complications before surgery (T₀) and at 1 d (T₁), 3 months (T₂), 6 months (T₃), 9 months (T₄) and 12 months (T₅) after surgery were recorded.

The NRS score of PHN patients at T₀, T₁, T₂, T₃, T₄, and T₅ [M(Q₁, Q₃)] was 6(6, 7), 2(2, 3), 3(2, 4), 3(2, 4), 2(1, 4), 2(1, 4), respectively. Likewise, the PSQI score [M(Q₁, Q₃)] at aforementioned time points was 14(13, 16), 4(3, 6), 6(4, 8), 5(4, 6), 4(2, 8), 4(2, 9), respectively. Compared with T₀, the NRS and PSQI scores at all time points from T₁ to T₅ were lower, with statistically significant differences (all P<0.001). The overall effective rate of surgery at 1 year postoperatively was 71.6% (73/102) with a satisfaction score of 8(5, 9), and the recurrence rate was 14.7% (15/102) with a recurrence time of (7.5±0.8) months. The main postoperative complication was numbness, with an incidence of 86.0% (88/102), and the degree of numbness gradually decreased with time.

CT-guided radiofrequency ablation of posterior root of spinal nerve for PHN has a high effective rate and a low recurrence rate, with high safety profile, and may be a feasible surgical option for the treatment of PHN.

To explore the efficacy and safety of coblation and pulsed radiofrequency on cervicogenic headache (CEH).

A total of 118 patients with CEH who underwent coblation or pulsed radiofrequency in the Department of Pain Management at Xuanwu Hospital, Capital Medical University from August 2018 to June 2020 was retrospectively collected. Patients were divided into the coblation group (n=64) and the pulsed radiofrequency group (n=54) according to different surgical methods. In the coblation group, there were 14 males and 50 females, aged 29-65 (49.8±10.2) years, while in the pulse radiofrequency group, there were 24 males and 30 females, aged 18-65 (41.7±14.8) years. Visual analogue scale (VAS) score, postoperative numbness in the affected areas and other complications were recorded and compared between the two groups at preoperative 3 d, and 1 month, 3 months and 6 months postoperatively.

The VAS score of the coblation group was (7.16±0.91), (3.67±1.13), (1.59±0.91), (1.66±0.84) and (1.56±0.90) before operation, and 3 days, 1 month, 3 months and 6 months after surgery. Likewise, the VAS score of the pulsed radiofrequency group was (7.01±0.78), (1.58±0.88), (1.57±0.94), (3.71±1.08) and (6.92±0.83) at the aforementioned time points. There were statistically significant differences of VAS scores between the coblation group and the pulsed radiofrequency group at 3 days, 3 months and 6 months postoperatively (all P<0.001). Intra-group comparison revealed that VAS scores in the coblation group were significantly lower than those before surgery at all time points after surgery (all P<0.001), while VAS scores in the pulsed radiofrequency group were significantly decreased at 3 days, 1 month and 3 months after surgery (P<0.001). The incidence of numbness was 72% (46/64), 61% (39/64), 6% (4/64) and 3% (2/62) in the coblation group and 7% (4/54), 7% (4/54), 2% (1/54) and 0 (0/54) in the pulsed radiofrequency group, respectively. At 3 days and 1 month after surgery, the incidence of numbness in the coblation group was higher than those in the pulsed radiofrequency group (both P<0.001). In the coblation group, one patient developed pharyngeal discomfort 3 days after surgery, which disappeared spontaneously 1 week after surgery without special treatment. One patient developed vertigo after getting up in the morning at 3 days postoperatively, and the possibility of transient cerebral ischemia was considered. In the pulsed radiofrequency group, one patient developed nausea and vomiting after operation, but spontaneous remission was observed after one hour without special treatment.

Both coblation and pulsed radiofrequency are effective and safe in the treatment of CEH. But the VAS scores at 3 and 6 months after coblation is significantly lower than those of pulsed radiofrequency ablation group, and the efficacy is better in those undergoing coblation.

To investigate the correlation between balloon volume and Meckel's cave size during percutaneous puncture microballoon compression (PMC) for trigeminal neuralgia and the influence of the compression coefficient (the ratio of balloon volume/Meckel's cave size) on the prognosis.

Seventy-two patients (28 males and 44 females) aged (62±11) years who underwent PMC under general anesthesia for trigeminal neuralgia in the First Affiliated Hospital of Zhengzhou University from February 2018 to October 2020 were retrospectively collected. All patients underwent preoperative cranial magnetic resonance imaging (MRI) to measure Meckel's cave size, intraoperative balloon volume was recorded, and the compression coefficient was calculated. Follow-up visits were performed preoperatively (T₀) and 1 d (T₁), 1 month (T₂), 3 months (T₃), and 6 months (T₄) postoperatively, either in the outpatient clinic or by telephone, and the Barrow Neurological Institute pain scale (BNI-P) score, the Barrow Neurological Institute facial numbness (BNI-N) score and the occurrence of complications were recorded and compared at each time point. Patients were divided into 3 groups according to different prognoses: patients in group A (n=48) were with no recurrence of pain and mild facial numbness, patients in group B (n=19) were with no recurrence of pain but severe facial numbness, while those in group C (n=5) had recurrence of pain. The differences in balloon volume, Meckel's cave size, and compression coefficient were compared among the three groups, and the correlation between balloon volume and Meckel's cave size in each group was analyzed by Pearson correlation.

The effective rate of PMC for trigeminal neuralgia was 93.1% (67/72). At time points from T₀ to T₄, patients had BNI-P scores [M (Q₁, Q₃)] of 4.5 (4.0, 5.0), 1.0 (1.0, 1.0), 1.0 (1.0, 1.0), 1.0 (1.0, 1.0) and 1.0 (1.0, 1.0), and BNI-N scores [M (Q₁, Q₃)] of 1.0 (1.0, 1.0), 4.0 (3.0, 4.0), 3.0 (3.0, 4.0), 3.0 (2.0, 4.0) and 2.0 (2.0, 3.0), respectively. Compared with those at T₀, patients had lower BNI-P scores and higher BNI-N scores from T₁ to T₄ (all P<0.05). In all patients, group A, group B, and group C, the balloon volume was (0.65±0.15), (0.67±0.15), (0.59±0.15) and (0.67±0.17) cm³, respectively, with no statistically significant difference (P>0.05), while the Meckel's cave size was (0.42±0.12), (0.44±0.11), (0.32±0.07), and (0.57±0.11) cm³, with a statistically significant difference (P<0.001). The balloon volumes and Meckel's cave sizes were all linearly and positively correlated (r=0.852, 0.924, 0.937 and 0.969, all P<0.05). The compression coefficient in group A, B and C was (1.54±0.14), (1.84±0.18) and (1.18±0.10), respectively, with a statistically significant difference (P<0.001). There were no serious intraoperative complications such as death, diplopia, arteriovenous fistula, cerebrospinal fluid leak, and subarachnoid hemorrhage.

Intraoperative balloon volume during PMC for trigeminal neuralgia is linearly and positively correlated with the volume of the patient's Meckel's cave. The compression coefficient varies among patients with different prognoses and the compression coefficient may be a factor affecting the patient's prognosis.

To investigate the efficacy and safety of pulsed radiofrequency of dorsal root ganglion combined with ozone injection on acute herpes zoster neuralgia in the neck and upper extremities.

A total of 110 patients with acute phase herpes zoster neuralgia in the neck and upper extremities treated in the Department of Pain of Jiaxing First Hospital from January 2019 to February 2020 were retrospectively included. The patients were divided into two groups according to different treatment modalities: the pulsed radiofrequency group (group A, n=68) and the pulsed radiofrequency combined with ozone injection group (group B, n=42). In group A, there were 40 males and 28 females, aged (71.9±9.9) years, while group B consisted of 23 males and 19 females, aged (66.3±16.9) years. Patients were followed up, and numerical rating scale (NRS) score, dose of adjuvant gabapentin, incidence of clinically significant postherpetic neuralgia (PHN) and adverse effects were recorded preoperatively (T₀) and at 1 d (T₁), 3 d (T₂), 1 week (T₃), 1 month (T₄), 2 months (T₅), and 3 months (T₆) postoperatively.

The NRS score of patients [M (Q₁, Q₃)] in group A at time points T₀, T₁, T₂, T₃, T₄, T₅ and T₆ was 6 (6, 6), 2 (2, 2), 3 (3, 4), 3 (2, 3), 2 (2, 3), 2 (1, 3) , 1 (0, 2), respectively, while the NRS score at aforementioned time points in group B was 6 (6, 6), 2 (1, 2), 3 (3, 4), 3 (2, 3), 2 (2, 3), 2 (1, 3), 1 (0, 2), respectively. Compared with preoperative NRS scores, NRS scores decreased in both groups at all postoperative time points (all P<0.05). Compared with group A, the NRS scores of group B at time points T₃, T₄, T₅, and T₆ decreased more significantly, with statistically significant differences (all P<0.05). The dose of gabapentin in group A [M (Q₁, Q₃)] was 0.6 (0.6, 0.6), 0.3 (0.3, 0.6), 0.3 (0.0, 0.3) and 0.0 (0.0, 0.3) mg/d at time points T₀, T₄, T₅, and T₆, respectively, and 0.6 (0.6, 0.6), 0.3 (0.2, 0.3), 0.0 (0.0, 0.3) 0.0 (0.0, 0.0) mg/d in patients in group B, respectively. Compared with the preoperative period, the doses of gabapentin taken by patients in both groups reduced significantly at all postoperative time points (all P<0.05). Moreover, compared with group A, the gabapentin dose in group B decreased more significantly at time points T₄, T₅, and T₆, with statistically significant differences (all P<0.05). The incidence of clinically significant PHN was 25.0% (17/68) and 7.1% (3/42) in groups A and B, respectively, and the differences were statistically significant (P=0.018). No serious adverse effects such as pneumothorax, spinal cord injury and hematoma were observed during the treatment period in both groups.

Pulsed radiofrequency of dorsal root ganglion combined with ozone injection is safer and more effective for the treatment of acute phase herpes zoster neuralgia in the neck and upper extremities, and it can reduce the incidence of clinically significant PHN, with high safety profile.

To investigate the features of morphological and functional parameters of cardiac magnetic resonance (CMR) in patients with systemic light chain (AL) amyloidosis, and the prognostic values of these related parameters.

The data of 97 patients (including 56 males and 41 females, aged 36 to 71 years) with AL amyloidosis from April 2016 to August 2019 in the General Hospital of Eastern Theater Command were retrospectively analyzed. All patients underwent CMR examination. Those patients were divided into survival (n=76) and death groups (n=21) according to the clinical outcomes, and the differences in clinical baseline and CMR parameters between the two groups were analyzed and compared. A smooth curve fitting was used to analyze the association between morphological and functional parameters and extracellular volume (ECV), and Cox regression models were conducted to explore the association between related parameters and mortality.

The left ventricular global function index (LVGFI), myocardial contraction fraction (MCF) and stroke volume index (SVI) decreased with increasing ECV [β (95%CI) was -0.566 (-0.685--0.446), -1.201 (-1.424--0.977), -0.149 (-0.293--0.004), respectively;all P<0.05]. Left ventricular mass index (LVMI), and diastolic left ventricular global peak wall thickness (LVGPWT) increased with increasing ECV [β(95%CI) was 1.440 (1.142-1.739), 0.190 (0.147-0.233), respectively;both P<0.001]. While left ventricular ejection fraction (LVEF) began to decrease only at higher amyloid burden (β=-0.460, 95%CI:-0.639--0.280, P<0.001). The median follow-up time was 39 months (range 2-64 months), and 21 patients died during the follow-up period. The estimated survival rates according to Kaplan-Meier curves at 1, 3, and 5 years were 92.8%, 78.7%, and 77.1%, respectively. MCF<39% (HR=10.266, 95%CI: 4.093-25.747) and LVGFI<26% (HR=9.267, 95%CI: 3.705-23.178) were independent risk factors for death in patients with AL amyloidosis after adjusting for other CMR parameters (P<0.001).

Multiple morphologic and functional parameters of CMR vary with the increase of ECV. MCF<39% and LVGFI<26% were independent risk factors for death.

To study the correlation between joint contact force and postoperative lower extremity alignment in Oxford unicompartmental knee arthroplasty (OUKA) and provide reference data for predicting the lower extremity alignment after OUKA.

It was a retrospective case series study. A total of 78 patients (92 knees) who underwent OUKA surgery from January 2020 to January 2022 in the Department of Orthopedics and Joint Surgery of China-Japan Friendship Hospital were included in this study, including 29 males and 49 females, aged (68.8±6.9) years. A custom-designed force sensor was used to measure gap contact force in the medial gap of OUKA. The patients were divided into groups according to the varus degree of lower limb alignment after operation. Relationship between the gap contact force and the alignment of the lower limbs after operation was analyzed with Pearson correlation analysis, and the gap contact force was compared between patients with different lower limbs alignment correcting results.

The mean contact force measured during the operation at 0° of knee extension was 81.7 N±57.8 N, and it was 96.1 N±54.5 N at 20° of knee flexion. The average postoperative knee varus angle was 2.9°±2.7°. The gap contact force at the 0° and 20° positions of the knee joint was negatively correlated with the varus degree of the postoperative lower limb alignment (r=-0.493, -0.331, both P<0.001). The distribution of gap contact force at 0° was different in each group, the contact force [M (Q₁, Q₃)] of the neutral position group(n=24) was 117.4 N (31.7 N, 233.0 N), and it was 63.7 N (11.3 N, 209.0 N), 31.5 N (8.3 N, 87.7 N) in the mild varus group (n=51) and the significant varus group (n=17), respectively, and the difference was statistically significant (P<0.001); while at 20°, only the difference between the significant varus group and the neutral position group was statistically significant (P=0.040). The gap contact force of the alignment satisfactory group at 0° and 20° was greater than those in the significant varus group (both P<0.05). The gap contact force measured at 0° and 20° was significantly greater in patients with preoperative significant flexion deformity than in patients without flexion deformity (or mild flexion deformity) (both P<0.05).

OUKA gap contact force is related to the degree of lower limb alignment correction after the operation. In patients with well-corrected lower limb alignment after surgery, the median intraoperative knee joint gap contact force at 0° and 20° is 117.4 N and 92.5 N, respectively.

To compare the efficacy among stand-alone oblique lateral lumbar interbody fusion (OLIF-SA), OLIF combined with lateral screw internal fixation (OLIF-AF) and OLIF combined with posterior percutaneous pedicle screw internal fixation (OLIF-PF) in the treatment of degenerative lumbar diseases.

The clinical data of patients with degenerative lumbar diseases who underwent OLIF-SA, OLIF-AF and OLIF-PF in the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University from January 2017 to January 2021 were retrospectively analyzed. Patients′ visual analogue score (VAS) and Oswestry disability index (ODI) at 1 week and 12 months postoperatively were recorded, and efficacy of OLIF surgery with different internal fixation methods was evaluated by comparing clinical scores and imaging examinations at preoperative, postoperative and follow-up, and bony fusion and postoperative complications were recorded.

A total of 71 patients were included in the study, with 23 males and 48 females, aged (65±11) (34-88) years. There were 25 patients in the OLIF-SA group, 19 patients in the OLIF-AF group, and 27 patients in the OLIF-PF group. Compared with those of OLIF-PF group [(196±46) min and 50 (50, 60) ml], OLIF-SA and OLIF-AF groups had shorter operative time [(97±38) min and (118±48) min] and less intraoperative blood loss [20 (10, 50) ml and 40 (20, 50) ml] (both P<0.001). There was no statistically significant difference in the fusion rate among three groups (P>0.05). No statistically significant differences of VAS and ODI scores were observed among OLIF-SA, OLIF-AF and OLIF-PF groups during preoperative period [VAS: 5.0 (4.0, 6.0), 5.0 (4.0, 6.0) and 5.0 (4.0, 5.3); ODI: 44.0% (35.0%, 47.0%), 46.5% (43.3%, 46.5%) and 43.5% (35.8%, 46.0%)], and at one week postoperatively [VAS: 2.0 (2.0, 3.0), 3.0 (2.0, 3.0) and 2.0 (2.0, 3.0); ODI: 13.0% (12.0%, 18.0%), 21.0% (13.5%, 21.8%) and 16.5%(14.0%, 21.0%)] and final follow-up [VAS: 1.0 (0, 1.0), 1.0 (1.0, 2.0) and 1.0 (1.0, 2.0); ODI: 7.0% (5.0%, 11.0%), 10.0% (7.0%, 14.8%) and 8.0% (6.0%, 12.0%)], respectively (all P>0.05).

Compared with OLIF-AF and OLIF-PF, OLIF-SA is a safe and effective surgical method with similar efficacy and fusion rates, decreases the cost of internal fixation, and reduces intraoperative time blood loss.

The data of 1 268 newly diagnosed gliomas from the Fourth Ward of Neurosurgery Department of Beijing Tiantan Hospital between April 2013 and March 2022 were retrospectively analyzed. Based on postoperative pathology, the gliomas were divided into groups: oligodendrogliomas (n=308), astrocytomas (n=337) and glioblastomas (n=623). According to the O6-methylguanine-DNA methyl transferase (MGMT) promoter status defined by the 12% of best cut-off value in previous research results, patients were divided into methylation group (n=763) and non-methylation group (n=505). Methylation level [M (Q₁, Q₃)] in patients with glioblastoma, astrocytoma and oligodendroglioma was 6% (2%, 24%), 17% (10%, 28%) and 29% (19%, 40%), respectively (P<0.001). Compared with non-methylation patients, the progression-free survival (PFS) and overall survival (OS) of glioblastomas patients with methylation of MGMT promoter demonstrated more favorable prognosis [M (Q₁, Q₃)]) of PFS: 14.0 (6.0, 36.0) months vs 8.0 (4.0, 15.0) months, P<0.001; M (Q₁, Q₃) of OS: 29.0 (17.0, 60.5) months vs 16.0 (11.0, 26.5) months, P<0.001]. In astrocytomas patients, the PFS was much longer for those with methylation [the median PFS of patients with methylation was not observed at the end of follow-up, but those without methylation showed a median PFS of 46.0 (29.0, 52.0) months] (P=0.001). However, no statistically significant difference was observed in OS [the median OS of patients with methylation was not observed at the end of follow-up, but those without methylation had a median OS of 62.0 (46.0, 98.0) months] (P=0.085). In oligodendrogliomas patients, no statistically significant differences of PFS and OS were observed between patients with methylation and those without methylation. MGMT promoter status was a related factor affecting PFS and OS in glioblastomas (PFS: HR=0.534,95%CI: 0.426-0.668, P<0.001; OS: HR=0.451, 95%CI: 0.353-0.576, P<0.001). Moreover, MGMT promoter status was also a related factor affecting PFS in astrocytomas (HR=0.462, 95%CI: 0.221-0.966, P=0.040), but not for OS (HR=0.664, 95%CI: 0.259-1.690, P=0.389). The methylation level of MGMT promoter differed substantially in different types of gliomas, and the status of MGMT promoter profoundly affected the prognosis of glioblastomas.

This study reports a patient who underwent surgical treatment for solitary plexiform neurofibroma (PNF). A 12-year-old male patient had an irregular subcutaneous mass of about 4 cm ×13 cm in the forehead. There was no significant specificity in CT, MRI and cerebral angiography of the brain, and hypoechoic nerve bundle-like structure was found in color Doppler ultrasound. Under general anesthesia, tumor marker range incision + coronary incision mass resection was performed. The postoperative pathology was consistent with PNF. After 6 months follow-up, the incision was flat and no recurrence was observed. This disease should be differentiated from vine hemangioma, neurofibromatosis type I and malignant peripheral schwannoma. During surgical resection, it is necessary to scientifically design the surgical incision, and make skin grafting and transfer flap to prevent possible skin defects and ischemic necrosis.

This article reports a case of Mikulicz's disease, which is relatively rare in clinical practice. The 18-year-old male patient was admitted to the hospital with "repeated redness and swelling of both eyes with foreign body sensation for 5 years and aggravation for 1 month". He had a history of "IgG4 immune-related diseases and asthma" in the past. He complained that he was well controlled after taking prednisone acetate tablets and relapsed after stopping the drug. CT and MRI examination showed symmetrical swelling of multiple glands in the head and neck, and infiltration along the pterygopalatine fossa; Immunoglobulin IgG was quantified at 21 g/L, and immunoglobulin subclass IgG4 was quantified at 22.4 g/L. During hospitalization, he continued to take glucocorticoid treatment, and the effect was remarkable. After the symptoms were relieved, he was discharged and continued conservative treatment. Combined with clinical symptoms, typical imaging findings, immunological examination and significant effects after hormone therapy, the disease was finally diagnosed as Mikulicz disease.

Liquid biopsy is the sampling and analysis of tumor-derived components through body fluids. Among them, liquid biopsy based on circulating tumor DNA (ctDNA) and circulating tumor cells (CTC) has been widely studied as relatively mature technologies, and has gradually entered clinical application. Compared with tissue biopsy, liquid biopsy has the advantages of convenient sampling, continuous monitoring and good repeatability. Radiotherapy is one of the important methods of tumor treatment. Based on the existing theories related to radiotherapy sensitivity, when using clinical staging and other commonly used clinical factors to guide radiotherapy dose formulation, balancing efficacy and toxicity and side effects still faces great challenges, highlighting the importance of strengthening the research of biomarkers related to radiotherapy sensitivity and finding new breakthrough directions. In view of this, this article mainly expounds the research results of ctDNA and CTC in the field of tumor radiotherapy from three aspects: tumor screening and early diagnosis, prognosis and risk stratification related to radiotherapy, and guiding treatment.

Hefacial spasm (HFS) refers to unilateral involuntary twitching of facial muscles, which can lead to functional blindness in severe cases. Its pathogenesis is mostly that the facial nerve root is compressed by accompanying blood vessels in the anterior pontic cistern, resulting in demyelination of nerve fibers and ectopic discharge, which is conducted to the effector (expression muscle) and causes involuntary twitching. At present, the first-line treatment plan is carnitine injection into expression muscle to block nerve-muscle excitation-contraction coupling, but the duration is only about 3 months; Craniotomy microvascular decompression can achieve the therapeutic effect by relieving the compression of accompanying blood vessels on nerves, but it is risky and expensive. This study describes a novel minimally invasive procedure: CT-guided percutaneous stylomastoid foramen partial facial nerve radiofrequency ablation (RFA) for HFS. By observing the clinical efficacy and safety follow-up of 53 patients with HFS who underwent CT-guided partial facial nerve RFA under conscious sedation for immediate and up to 19 months, it was found that the mean operation time of partial facial nerve RFA was only 32~34 min. 91% of patients (48/53) had complete HFS remission after surgery, and mild to moderate facial paralysis that could recover within one month could provide effective relief for patients with HFS lasting more than 15 months. This study suggests that CT-guided partial RFA of facial nerve of stylomastoid foramen can effectively block the conduction of ectopic electrical excitation to expression muscle, thus relieving hemifacial spasm for a long time. This technique is a minimally invasive procedure without intracranial entry, and according to current efficacy observations, it can be an effective treatment option for HFS.

At present, the treatment methods of trigeminal neuralgia include nerve block, radiofrequency ablation, balloon compression, craniotomy and microvascular decompression, etc. Among them, the classic balloon compression treatment is to complete the puncture operation under the guidance of C-arm X-ray under general anesthesia. Because of the inability to communicate with patients under general anesthesia, the effective standard of surgery can only be judged by the "inverted pear shape" of the lateral X-ray projection of the inflated balloon. This study describes the method of CT-guided percutaneous balloon compression in the treatment of trigeminal neuralgia in awake state, and observes its efficacy and safety. A total of 66 patients with medically refractory trigeminal neuralgia were enrolled in this study. The surgery was performed under moderate sedation and consciousness. After the balloon catheter was inserted through a trocar under CT guidance to reach the Meckel cavity, the position and optimal morphology of the filling balloon were determined by CT three-dimensional reconstruction. The efficacy was judged according to the intraoperative test of patients with facial hypoesthesia or disappearance of trigeminal neuralgia symptoms. All patients were followed up for 12 months and monitored for efficacy and complications. The trigeminal ganglion compression time was (272 ± 81) s, when there was significant facial hypoesthesia on the affected side, or resolution of triggered pain on the affected side, compared to the contralateral side. Trigeminal neuralgia symptoms were relieved within 6 months in all patients, with a 1-year recurrence rate of 13%. The CT-guided balloon compression technique described in this study improves the overall safety of trigeminal neuralgia treatment because it can communicate with patients during surgery, is easy to test the efficacy, and CT guidance is more accurate than X-ray fluoroscopy guidance.

Meige syndrome, also known as segmental craniocervical dystonia, currently lacks an effective treatment. Treatment of dystonia can be achieved by blocking the generation and transmission of abnormal motor signals. Meige syndrome (craniocervical dystonia often symmetrically distributed on both sides of the craniofacial axis) is not caused by concomitant vascular compression of cranial nerve roots, so it cannot be treated by craniotomy microvascular decompression. The present study found that CT-guided radiofrequency ablation of bilateral stylomastoid facial nerve and/or trigeminal mandibular branch of foramen ovale can effectively treat the corresponding type of Meige syndrome. According to preliminary observation, the efficacy can last for more than 18 months. Current studies include blepharospasmic dystonia syndrome (BDS), oromandibular dystonia syndrome (ODS), blepharospasm with oromandibular dystonia syndrome (B-ODS). BDS patients underwent bilateral radiofrequency ablation of facial nerve of stylomastoid foramen; Patients with ODS underwent bilateral radiofrequency ablation of the mandibular branch of the trigeminal nerve of the foramen ovale, and patients with B-ODS underwent bilateral radiofrequency ablation of the facial nerve of the stylomastoid foramen and the mandibular branch of the trigeminal nerve of the foramen ovale. This study showed that after radiofrequency treatment of bilateral facial nerves, there was simultaneous mild facial paralysis without skewed mouth angles, but the sucking ability was significantly reduced, resulting in the inability of the patient to complete the smiling action, and other than this, no other complications occurred. After radiofrequency surgery of the mandibular branch of the bilateral trigeminal nerve, there was no difficulty in opening the mouth. However, there is still dullness and numbness in the innervation area of the mandibular branch of the bilateral trigeminal nerve. After 24 months of follow-up, 2 patients experienced symptom relapse at 18 and 22 months, respectively. CT-guided extracranial radiofrequency ablation of bilateral facial nerve in stylomastoid foramen and/or mandibular branch of trigeminal nerve in foramen ovale may be a feasible treatment option for Meige syndrome. In addition to botulinum toxin injection and deep brain electrical stimulation, extracranial cranial nerve radiofrequency technology may become a new therapy for Meige syndrome.