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To construct an animal model with a high consistency of trigeminal neuralgia, this paper systematically reviewed and summarized the existing animal models based on the etiology and pathogenesis analysis of Chinese and western medicine, clinical diagnostic criteria and evaluation indexes of animal models. Methods Literatures on animal models of trigeminal neuralgia were consulted through CNKI and PubMed databases, the etiology and pathogenesis of Chinese and western medicine in the treatment of TN, diagnostic criteria of Chinese and western medicine, model replication objects in common animal models of trigeminal neuralgia, model replication methods and consistency of clinical manifestations of Chinese and western medicine were summarized and analyzed. Results At present, the most widely used model is the "infraorbital nerve injury" surgical model, which has high similarity in pathological manifestations with the clinical features of trigeminal neuralgia. Secondly, the chemical induction model of "penicillin injection" showed significant effect of inducing acute pain-like reactions. The photochemical induction model can effectively avoid the influence of factors such as tightness during surgical modeling process on the experimental results. Conclusion The current modeling method of integrated traditional Chinese and western medicine is still in the stage of exploration and has not formed a mature theoretical system. Therefore, we should actively invest more resources to develop animal models more closely related to traditional Chinese medicine (TCM) syndromes in future research. The purpose is to provide strong theoretical basis and experimental support for the treatment of trigeminal neuralgia with integrated Chinese and western medicine. [ABSTRACT FROM AUTHOR]

Objective To investigate whether focal demyelination in the pontine trigeminal tracts (PTTs) can induce trigeminal neuralgia-like behaviors in adult rats. Methods Brain stereotaxic microinjection technology was used to inject 1% lysophosphatidylcholine (LPC) or 1× PBS into the PTT region of male SD rats (weighing 250~270 g) to establish the PTT demyelination model group (LPC group) and control group, respectively. Myelin fluorescent staining was employed to evaluate the demyelination changes in the PTT region. Behavioral experiments were performed to measure the mechanical stimulation threshold of head withdraw response, unilateral eyelid contraction duration and numbers of fast face stroking in rats. Intraperitoneal injection of 50 mg/kg carbamazepine was given to the rats to evaluate their behavioral changes. Results A stable local demyelination model of PTT in adult rats was successfully established by, with the coordinate origin at Bregma, descending glass microelectrode for 9.22 mm with a left-side 18° tilt path from axterior-posterior (AP) -9.86 mm, medial-lateral (ML) 0 mm and dorsal-ventral (DV) 0 mm, and then 250 nL 1%LPC was injected at a rate of 250 nL/min. Myelin fluorescent staining demonstrated that the peak of demyelination was observed at the 7th day after modeling. Behavioral experiments showed that compared with the control group, the air-puff gas stimulation threshold and von Frey filament stimulation threshold that triggered the head withdraw response were significantly reduced in the LPC group (P < 0.01). At the 7th day after modeling, there were significant increases in the unilateral eyelid contraction duration and the numbers of unilateral fast face stroking only in the adult rats from the LPC groups (P < 0.01). Carbamazepine significantly decreased the numbers of unilateral fast face stroking evoked by mechanical stimulation (P < 0.01). Conclusion Focal demyelination in the PTTs can induce trigeminal neuralgia-like behaviors in adult rats.

Objective To screen the risk factors related to primary trigeminal neuralgia (PTN) based on radiomics. Methods A total of 48 patients with PTN admitted to Guangdong Second Provincial General Hospital from January 2017 to December 2020 were selected. The mean arterial pressure (MAP) of the patients was measured, and the neurovascular compression model was constructed by head MRI examination. Univariate and multivariate Logistic regression analyses were used to screen for risk factors associated with PTN, and the predictive efficacy was evaluated by receiver operating characteristic (ROC) curve according to the risk factors. Results Among 48 patients, 42 patients (87.50%) had unilateral lesions and 6 patients (12.50%) had bilateral lesions. The MAP was 56.89-120.44 mm Hg, with an average of (94.32 ± 11.34) mm Hg. The neurovascular compression model of 54 cases was divided into the affected side (n = 40) and the healthy side (n = 14) according to whether the disease occurred. The neurovascular compression area (Z = - 2.823, P = 0.005) and neurovascular pressure (Z = - 0.365, P = 0.006) on the affected side were greater than those on the healthy side. Logistic regression analyses showed that high neurovascular pressure (OR = 1.001, 95%CI: 1.0003-1.0022; P = 0.011) was a risk factor for PTN. ROC showed the area under the curve (AUC) of neurovascular compression area for predicting PTN was 0.747 (95%CI: 0.605-0.890, P = 0.006), the sensitivity was 42.50%, the specificity was 100%, and the cut-off value was 25.34 mm2. The AUC of neurovascular pressure was 0.755 (95%CI: 0.616-0.895, P = 0.005), the sensitivity was 67.50%, the specificity was 78.60%, and the cut - off value was 1672.99 mm Hg·mm2. Conclusions The neurovascular compression area and neurovascular pressure are important in the diagnosis of PTN.

Objective: T Exploring the clinical characteristics of primary trigeminal neuralgia (PTN) and postherpetic trigeminal neuralgia (PHN), and studying the clinical efficacy of radiofrequency thermocoagulation through foramen ovale (RF-TC) in the treatment of PTN and PHN. Methods: Randomly select 123 patients with trigeminal neuralgia who were treated in our hospital from January 2019to August 2020, including 90 cases of primary trigeminal neuralgia and 33 cases of postherpetic neuralgia. All patients were treated with RF-TC. After treatment, pain was assessed using the Visual Analog Scale (VAS), Barrow Neurological Institute Pain Intensity Scale, and Facial Pain Score. numbness was assessed using the Barrow Neurological Institute numbness score. Depression was assessed using the Health Questionnaire-9. The psychological state of patients was measured using the Pittsburgh Sleep Quality Index. Results: The onset age of PTN patients was significantly lower than that of PHN patients (P＜0.05), and the course of disease was significantly higher than that of PHN patients (P＜0.05), while the incidence of ocular branches in PHN patients was higher than that in PTN patients (39.39% vs8.89%, P＜0.05) . There was no significant difference in VAS scores between the two groups of patients before and after RF-TC treatment (P＞0.05) . The proportion of mild to severe effects on sleep quality in the PHN group was significantly higher than that in the PTN group (51.51% vs 35.56%, P＜0.05) . The proportion of patients with moderate to severe depression in the PTN group after treatment was significantly higher than that in the PHN group (21.11% vs 9.09%, P＜0.05) . After RF-TC treatment, there was no significant difference in clinical treatment efficacy, facial numbness, and facial pain assessed by the Barrow Neurology Institute Pain Intensity Scale between the two groups of patients (P＞0.05) . Conclusion: Radiofrequency thermocoagulation through the foramen ovale is a safe and effective treatment for primary trigeminal neuralgia and post herpetic trigeminal neuralgia. However, the incidence of insomnia in post herpetic trigeminal neuralgia is higher, while the incidence of depression in primary trigeminal neuralgia is higher. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical effect of percutaneous balloon compression (PBC） guided by DSA in the treatment of primary trigeminal neuralgia (PTN). Methods The clinical and follow-up data of 50 patients with PTN treated by PBC under DSA from January 2019 to October 2021 in Affiliated Brain Hospital of Medical College of Jinan University were analyzed retrospectively. The relationship between gender, age, course of disease, affected side, balloon shape, degree of facial numbness, pain recurrence and curative effect was statistically analyzed. Results The pain immediate relief rate after operation was 100%. During the follow-up, 9 pain recurred, and the short-term recurrence rate was 18.0%. 44 were cured, and the cure rate was 88.0%. 3 were markedly effective. 1 was effective. 2 were ineffective. The effective rate was 96.0%. Age, gender, affected side, course of disease, balloon shape had no significant differences in efficacy (P＞0.05). The degree of facial numbness and pain recurrence had statistically significant difference in efficacy (P＜0.05). Conclusions DSA-guided PBC for the treatment of PTN is minimally invasive and effective. The degree of postoperative facial numbness≤Ⅱ grade and pain recurrence are two main factors affecting the clinical efficacy. [ABSTRACT FROM AUTHOR]

Objective Trigeminal neuralgia is the most common maxillofacial pain syndrome, and its etiology has not been fully understood. In this paper, we focus on the role and expression of G protein-gated inwardly rectifying potassium channel (GIRK) protein in trigeminal neuralgia to provide a new direction for the treatment of trigeminal neuralgia. Methods An animal model of trigeminal neuralgia in mice was established by infraorbital nerve transection surgery, and its mechanical abnormal pain was measured by using Von Frey; the number of facial scratches was recorded to measure its spontaneous pain; the expression of GIRK protein in trigeminal ganglion was detected by Western Blot. Results Our research discovered that after trigeminal nerve injury in mice, both mechanical abnormal pain and spontaneous pain were significantly enhanced at 3-21 days postoperatively compared to controls, while both GIRK1-3 protein levels were downregulated in the trigeminal ganglion. Conclusion Trigeminal neuralgia model in mice was successfully established， and suggesting that GIRK may play a significant role in trigeminal neuralgia after nerve injury.

Objective This study aimed to investigate whether the microglia in the spinal trigeminal nucleus caudal part (Sp5C) were activated in a rat model of trigeminal neuralgia and to explore whether the activation level of microglia is consistent with maxillofacial pain level. Methods Chronic constriction injury of trigeminal nerve (CCI) was induced by partial ligation of infraorbital nerve (IoN) in rats. The behavioral change of rats observed at D1, D5, D10, D15, and D30 days post-surgery and the change of pain threshold were detected with electronic Von Frey filaments served as an evaluation index of maxillofacial pain. Weight change was measured by weighing. Ionized calcium binding adaptor molecule- 1 (Iba-1) expression level of Sp5C at each time point was detected, and three microglia morphological categories were analyzed by immunohistochemical staining. Results The changes of behavioral and pain threshold suggested the maxillofacial pain level first increased and then decreased post-surgery in the IoN-CCI group. Both the expressions of Iba-1 and proportion of ameboid morphology in ipsilateral Sp5C increased from D1 and reached their peaks in D10 and D5, respectively. Then, they recovered nearly to the same level with contralateral Sp5C on D30. This trend was consis consistent with the maxillofacial change. Conclusion The model of trigeminal neuralgia in rats constructed by partial ligation of infraorbital nerve can induce the activation of microglia in Sp5C, and the activation level is consistent with maxillofacial pain, which reached its peak at around D10 post-surgery. [ABSTRACT FROM AUTHOR]

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Trigeminal neuralgia (TN) is a common headache or orofacial pain, which can be divided into idiopathic TN, classical TN and secondary TN. Minimally invasive intervention is an important treatment method for idiopathic TN and classical TN. Percutaneous foramina ovale puncture of semilunar ganglion is a classic approach for minimally invasive interventional of TN, and improving the success rate of puncture is an important link to ensure curative effect and reduce complications. There are a variety of puncture guidance methods in clinical operation. In this paper, relevant literature on different puncture guidance methods of transcutaneous skull base foramina ovale for TN in recent years was reviewed to provide reference for minimally invasive interventional treatment of TN. [ABSTRACT FROM AUTHOR]

Trigeminal neuralgia (TN) is a recurrent facial paroxysmal pain in the distribution area of trigeminal nerve. About 12 - 29 people suffer from TN in every 100000 people. Antiepileptic drugs and tricyclic antidepressants are the first-line drugs for TN. The surgical indications of TN patients are patients with intolerable side effects or unrelieved symptoms after treatment with at least three drugs. Surgical treatment and radiotherapy are divided into nerve injury treatment and non-nerve injury treatment. In addition, neuromodulation stimulation techniques such as cerebral motor cortex stimulation (MCS) and deep brain stimulation (DBS) are emerging technologies, which can also alleviate the pain degree of TN. This paper summarizes the history and latest progress of non-drug treatment of TN, so as to provide a theoretical basis for patients to provide a more reasonable individualized treatment scheme. [ABSTRACT FROM AUTHOR]

Objective To investigate the individualized treatment of recurrent trigeminal neuralgia ( TN) after microvascular decompression( MVD). Methods The clinical data of 34 patients with recurrent TN after MVD were retrospectively analyzed. The patients were evaluated by preoperative imaging examination and individualized treatment plan was selected. The postoperative efficacy and complications were analyzed. Results In this group, 15 patients were performed MVD again because of wide subarachnoid space, vascular comp ression and no obvious contraindication. The pain disappeared in 14 patients, relieved in 1 patient, and facial numbness occurred in 3 patients without recurrence. 19 patients underwent percutaneous trigeminal semilunar ganglion balloon compression ( PBC) . The facial pain disappeared in all patients, but facial numbness occurred in all patients. There were 11 cases of masticatory muscle weakness, 1 case of keratitis and 2 cases of lip herpes. One patient had pain recurrence 10 months after operation. Conclusion The recurrence of TN after MVD can be cured by MVD and PBC. Individualized treatment should be selected according to imaging evaluation and patient condition. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the effects of berberine hydrochloride on the inflammatory signaling pathway of NOD-like receptor protein 3 (NLRP3) in rats with trigeminal neuralgia (TN) and its protective effect on TN rats. METHODS: TN rat model was made by chronic constriction injury of infraorbital nerve model (ION-CCI) method. The successfully modeled rats were randomly divided into the model group, low-dose group, medium-dose group and high-dose group of berberine hydrochloride (25 mg / kg, 50 mg / kg, 100 mg / kg), with 15 rats in each group. Another 15 rats (only the infraorbital nerve was isolated, without ligation) were taken as the sham operation group. The sham operation group and the model group were given the same amount of normal saline by gavage. The other groups received the corresponding dose of berberine hydrochloride by gavage with the volume of 10 ml / kg, once a day for 14 d. The mechanical pain threshold of facial innervation at different time points were measured by electronic pain tester. The levels of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) in trigeminal ganglia of rats were detected by enzyme-linked immunosorbent assay (ELISA). The expression level of calcitonin gene-related peptide (CGRP), NLRP3, apoptosis-related speckle-like protein (ASC) and caspase-1 mRNA in the trigeminal ganglion tissues of rats were detect by real-time fluorescent quantitative polymerase chain reaction (qRT-PCR). And the expression level of CGRP, NLRP3, ASC and caspase-1 protein in trigeminal ganglia were detected by Western Blot. RESULTS: Before modeling of 3 d and 1 d, there was no statistically significant difference in mechanical pain threshold among four groups (P>0. 05). After modeling of 3 d and 1 d, compared with the sham operation group, the mechanical pain threshold in the model group decreased, with statistically significant difference (P<0. 05), and there was no statistically significant difference between the model group and low-dose group, medium-dose group and highdose group of berberine hydrochloride (P>0. 05). After modeling of 5 to 14 d, compared with the sham operation group, the mechanical pain threshold in the model group decreased, with statistically significant difference (P < 0. 05); compared with the model group, the mechanical pain threshold of low-dose group, medium-dose group and high-dose group of berberine hydrochloride increased in turn with dose-dependent (P<0. 05). On the 15th d after surgery, compared with the sham operation group, the level of IL-1β, TNF-α and the expression level of mRNA and protein in CGRP, NLRP3, ASC and caspase-1 in trigeminal ganglion tissue of the rats in the model group increased, with statistically significant difference (P<0. 05); compared with the model group, the level of IL-1β, TNF-α and the mRNA and protein expression level of CGRP, NLRP3, ASC and caspase-1 in the trigeminal ganglion tissue of the rats in the low-dose group, medium-dose group and high-dose group of berberine hydrochloride decreased in turn with dosedependent (P<0. 05). CONCLUSIONS: Berberine hydrochloride may reduce the release of inflammatory factors by down-regulating the signal pathway of NLRP3 inflammatory corpuscle, decrease the expression level of CGRP in trigeminal ganglion tissues, and increase the mechanical pain sensitivity threshold of the neurofacial sensory area, so as to reduce the injury of TN on rats. [ABSTRACT FROM AUTHOR]

To investigate the effect of microvascular decompression (MVD) combined with partial sensory rhizotomy (PSR) on pain score, quality of life and sleep status in patients with primary trigeminal neuralgia (TN). The clinical data of 80 patients with primary TN who were admitted to our hospital from February 2015 to March 2019 were analyzed retrospectively. According to the different operation methods, the patients were divided into control group (n=40, MVD treatment) and study group (n=40, MVD combined with PSR treatment). The pain score, quality of life, perioperative indicators, sleep status, complications and recurrence rate of the two groups were compared. The visual pain simulation scale (VAS) scores of the two groups after treatment were lower than before treatment, and those of the study group were lower than those of the control group (P<0.05). The scores of short form-36 (SF-36) of the two groups after treatment were higher than those before treatment, and the scores of the study group were higher than those of the control group (P<0.05). The scores of all items in Pittsburgh sleep quality index (PSQI) of the two groups after treatment were higher than those before treatment, and the scores of the study group were higher than those of the control group (P<0.05). The hospitalization time of the study group was shorter than that of the control group, and the operation time was longer than that of the control group (P<0.05). There was no significant difference in intraoperative blood loss between the two groups (P>0.05). The total incidence of complications of the study group was lower than that of the control group (P<0.05). There was no significant difference in recurrence rate between the two groups during follow-up (P>0.05). MVD combined with PSR in the treatment of primary TN, although the operation time is longer, it has a significant effect in alleviating patients' pain, improving patients' quality of life and sleep status, and reducing the incidence of complications. [ABSTRACT FROM AUTHOR]

Objective To analyze the efficacy and safety of pure microvascular decompression (MVD) for trigeminal neuralgia (TN), and to screen related risk factors for TN recurrence. Methods A total of 286 primary TN patients underwent pure MVD. Barrow Neurological Institute (BNI) grade was used to evaluate the relief of TN before and after surgery and during the follow-up. Postoperative complications were recorded, including facial numbness of operation side, hearing loss of operation side, cerebrospinal fluid (CSF) leakage, poor wound healing, intracranial infection and hydrocephalus. The recurrence during follow-up was also recorded. Univariate and multivariate forward Logistic regression analysis were used to screen related risk factors of recurrent TN. Results Of all patients, 18 cases (6.29%) had slight facial numbness of operation side after surgery, 13 cases (4.55% ) had hearing loss of operation side after operation. One (0.35%) had CSF leakage, and was cured after lumbar cistern drainage. One (0.35%) had no wound healing, and was cured after bone wax and repairing titanium mesh were removed in the reoperation. Two cases (0.70% ) had intracranial infection and were cured by antibiotic therapy. One (0.35%) had hydrocephalus and was cured after external ventricular drainage. Of 286 patients, 26 cases (9.09%) were lost during the follow-up, 13 cases (4.55%) had no pain relief after surgery, 13 cases (4.55%) had partial pain relief after surgery and 234 cases (81.82%) had complete pain relief after surgery. The follow-up period of 234 cases was a mean of 31.29 months. During follow-up, one case (0.35%) died of heart disease, and 28 cases (9.79%) had pain recurrence. Kaplan-Meier curve showed the rate of complete pain relief was decreased with time, the recurrence rate was 5.4% one year after surgery, 15.2% 3 years after surgery, and 21.2% 5 years after surgery. Univariate and multivariate forward Logistic regression analysis showed preoperative BNI grade Ⅴ was independent risk factor for recurrence of TN (OR = 2.385, 95%CI: 1.063-5.353; P = 0.035). Conclusions Pure MVD for treating TN is safe and effective, without postoperative death or severe complications. DOI: 10.3969/j.issn.1672-6731.2018.10.003

Objective To compare the efficacy and safety of microvascular decompression (MVD) and non-surgical treatment for treating senile idiopathic trigeminal neuralgia (ITN). Methods A total of 133 patients older than 75 years with ITN respectively received MVD (N = 80) and non-surgical treatments (N = 53) such as pulse radiofrequency in 38 cases, stereotactic gamma knife radiotherapy in 10 cases, and acupuncture and moxibustion in 5 cases. McGill Pain Questionnaire (MPQ) was used to evaluate the degree of pain improvement. World Health Organization Quality of Life Scale-100 (WHOQoL-100) was used to evaluate life quality. Postoperative complications were recorded, including facial blunt sensation, headache, nausea and vomiting, pneumonia, intracranial infection, cerebrospinal fluid (CSF) leakage, deep venous thrombosis, incomplete facial paralysis, hearing loss and dyskinesia. Results In MVD group, 79 cases (98.75%) had complete pain relief and one case (1.25%) had partial pain relief after operation. There were 8 cases (15.09% ) with complete pain relief, 33 cases (62.26% ) with partial pain relief, and 12 cases (22.64% ) without pain relief in non-surgical treatment group. The difference between 2 groups was statistically significant (χ2 = 84.241, P = 0.000). After 55.80 (35.74, 63.48) months follow-up, the recurrence rate of MVD group was significantly lower than that of non-surgical treatment group [8.75% (7/80) vs. 35.85% (19/53); χ2= 16.558, P = 0.000]. The life quality of MVD group was better than that of non-surgical treatment group [WHOQoL-100 (27.82 ± 2.10) score vs. (22.19 ± 7.22) score; t = 1.202, P = 0.039]. The occurrence of postoperative complications such as facial blunt sensation, headache, nausea and vomiting were high in both groups, while the occurrence of pneumonia, intracranial infection, CSF leakage, deep venous thrombosis, incomplete facial paralysis, hearing loss and dyskinesia were rare in both groups. No case was dead. The incidence of facial blunt sensation in MVD group was significantly lower than that in non-surgical treatment group [8.75% (7/80) vs. 86.79% (46/53); χ2 = 81.005, P = 0.000]. Conclusions MVD is safe and effective in the treatment of senile ITN, so it is suggested that MVD should be the first choice for patients with ITN, unless they cannot tolerate general anesthesia. DOI: 10.3969/j.issn.1672-6731.2018.10.004

Objective To investigate the influence of the number of offending vessels on clinical efficacy and safety of microvascular decompression (MVD) in the treatment of trigeminal neuralgia (TN). Methods A total of 80 idiopathic TN patients underwent MVD were divided into 2 groups: single offending vessel group (N = 48) and multiple offending vessels group (N = 32). Visual Analogue Scale (VAS) was used to evaluate the degree of pain before and after surgery. Brisman Standard was used to evaluate curative effect and calculate total effective rate. Postoperative complications (fever, angular numbness, hearing loss, transient trochlear nerve palsy, swelling of incision) and recurrence rate one year after MVD were recorded. Results The VAS scores of 2 groups after operation were significantly lower than before operation (F = 5.871, P = 0.000). There was no significant difference on VAS scores between 2 groups (F = 1.192, P = 0.318). In 48 patients of single offending vessel group, 40 cases (83.33%) were cured, 4 cases (8.33%) had obvious effect, 2 cases (4.17%) were improved and 2 cases (4.17%) had no effect. The total effective rate was 95.83% (46/48). Seven cases (14.58%) presented postoperative complications, including fever in 4 cases (8.33%), angular numbness in one case (2.08%), transient trochlear nerve palsy in 2 cases (4.17%). TN recurred in 2 cases (4.17%). In 32 patients of multiple offending vessels group, 27 cases (84.38%) were cured, 3 cases (9.38%) had obvious effect, one case (3.13%) was improved and one case (3.13% ) had no effect. The total effective rate was 96.88% (31/32). Six cases presented postoperative complications, including fever in 4 cases (12.50%), hearing loss in one case (3.13%), swelling of incision in one case (3.13%). TN recurred in 2 cases (6.25%). There were no significant differences in total effective rate (χ2 = 1.863, P = 0.485), incidence of postoperative complication (χ2= 2.119, P = 0.378) and postoperative recurrence rate (adjusted χ2 = 2.075, P = 0.391) between 2 groups. Conclusions MVD has similar clinical effects and safety in the treatment of TN patients with single or multiple offending vessels. DOI: 10.3969/j.issn.1672-6731.2018.10.005

Objective To evaluate the changes of pain and sensory function in patients with idiopathic trigeminal neuralgia (ITN) treated by adriamycin interventional treatment, and to explore their correlation. Methods A total of 23 patients with ITN were treated by adriamycin interventional treatment guided via CT. Visual Analogue Scale (VAS) was used to evaluate the degree of pain before treatment and 1 d, 7 d, 1 month, 3 months, 6 months, 12 months after treatment. Quantitative Sensory Testing (QST) was used to measure cold sensation (CS), warm sensation (WS), cold pain (CP) and hot pain (HP) threshold value of chin at the affected side. Results Compared with before treatment, VAS scores decreased at 1 d, 7 d, 1 month, 3 months, 6 months and 12 months after treatment (P = 0.000, for all). One month, 3 months, 6 months and 12 months after treatment, CS (P = 0.003, 0.000, 0.000, 0.000) and CP (P = 0.022, 0.000, 0.000, 0.013) decreased, while WS (P = 0.004, 0.002, 0.000, 0.000) and HP (P = 0.004, 0.002, 0.000, 0.000) increased. Pearson correlation analysis showed VAS scores were positively correlated with CS (r = 0.703, P = 0.000) and CP (r = 0.679, P = 0.002), and negatively correlated with WS (r = -0.782, P = 0.000) and HP (r = -0.726, P = 0.001) after adriamycin interventional treatment. Conclusions QST was confirmed as noninvasive, simple and objective measurement. It could be used to quantificationally analyze the damage of sensory nervous function and could be a valuable index in evaluating the curative effect of trigeminal nerve destruction.

In 2015, Chinese neurosurgical experts formulated the "Chinese expert consensus on diagnosis and treatment of trigeminal neuralgia" to provide a reliable basis for improving the clinical diagnosis and treatment of trigeminal neuralgia (TN). The author interprets main contents of the consensus with personal knowledge and clinical experience, mainly discussing the clinical diagnosis and differential diagnosis of TN, and expounding the indications, clinical efficacy and complications of TN, so as to provide a clearer way of thinking for clinicians with the right choice on diagnosis and treatment of TN.

Objective To explore clinical features and surgical outcome of primary and secondary trigeminal neuralgia (TN). Methods A total of 105 cases of TN, including 90 primary and 15 secondary TN cases, were treated with microvascular decompression (MVD) or primary lesion resection and trigeminal nerve detection followed by necessary MVD, respectively. The postoperative effect and neurological complications (including hearing loss, symptomatic ischemic stroke and facial nerve injury) were evaluated. Results Of all 90 cases of primary TN, 85 cases underwent MVD via suboccipital retrosigmoid approach (85 cases, 100%), offending vessels were detected in 81 cases (95.29%), neuralgia was relieved in 84 cases (98.82%) after surgery, and neurological complications were detected in one case (1.18%) manifested as hearing loss. Of 15 cases of secondary TN, primary lesions were resected with surrounding vessels exploration [12 cases (12/15) through suboccipital retrosigmoid approach and 3 cases (3/15) through infratemporal tentorial approach]. Primary lesion resection and trigeminal nerve detection were applied followed by necessary MVD. Offending vessels were detected in 3 cases (3/15), all 15 cases (15/15) had neuralgia relieved, and 7 cases (7/15) had neurological complications in secondary TN, including hearing loss in 5 cases, symptomatic ischemic stroke in one case, and facial nerve injury in 6 cases. Postoperative pathological examination showed acoustic neuroma in 5 cases (5/15), epidermoid cyst in 4 cases (4/15), endothelioid meningioma (WHOⅠ) in 2 cases (2/15), transitional meningioma (WHOⅠ) in 2 cases (2/15) and cerebellar arteriovenous malformation in one case (1/15). One case (1/15) with arachnoid cyst did not perform pathological examination. In the primary TN cases, the age at initial symptom onset was older [(51.61 ± 12.21) years vs. (44.87 ± 11.87) years; t = 1.988, P = 0.049], the ratio of cases with preoperative hearing loss was lower [0 (0/90) vs. 7/15; adjusted χ2 = 37.813, P = 0.000], the ratio of surgeries through suboccipital retrosigmoid approach was higher [100% (85/85) vs. 12/15; adjusted χ2 = 11.327, P = 0.001], the ratio of offending vessels detected during surgery was higher [95.29% (81/85) vs. 3/15; adjusted χ2 = 48.325, P = 0.000], the ratio of postoperative complications was lower [1.18% (1/85) vs. 7/15; adjusted χ2 = 29.934, P = 0.000] than those in secondary TN cases, respectively. Conclusions Differences are noted in clinical features between primary and secondary TN. Hearing loss considering as early symptom may suggest primary lesion in secondary TN. Appropriate surgical approach should be selected for surgery according to specific lesions. During surgery, all surrounding vessels of cisternal segment of trigeminal nerve should be explored to achieve sufficient decompression of trigeminal nerve. The rate of pain relief after operation is high in both primary and secondary TN, while neurological complications may occur in secondary TN after surgery.

Objective To analyze the efficacy and safety of microvascular decompression (MVD) for the treatment of elderly patients with trigeminal neuralgia (TN). Methods A total of 286 primary TN patients [50 cases of age ≥ 70 years (older group) and 236 cases of age < 70 years (younger group)] underwent MVD via suboccipital sigmoid approach. Postoperative complications were recorded, including facial numbness of operation side, hearing loss of operation side, cerebrospinal fluid (CSF) leakage, poor wound healing, intracranial infection and hydrocephalus. Barrow Neurological Institute (BNI) grade was used to evaluate the relief of TN before and after surgery and during the follow-up. The recurrence rate during follow-up period was recorded. Results Of all cases, 36 (12.59%) presented with postoperative complications, including 18 cases (6.29%) of facial numbness of operation side, 13 cases (4.55%) of hearing loss of operation side, one case (0.35%) of CSF leakage, one case (0.35%) of poor wound healing, 2 cases (0.70% ) of intracranial infection and one case (0.35% ) of hydrocephalus. In those 36 cases, 29 cases (12.29% ) were in younger group and 7 cases (14% ) were in older group, and there was no significant difference between 2 groups (χ2 = 0.110, P = 0.740). The mean follow-up period was 29.43 months. During the follow-up, 170 cases (78.70%) had complete pain relief (BNI gradeⅠ), 10 cases (4.63%) had partial pain relief (BNI gradeⅡ-Ⅲ), 14 cases (6.48%) had no pain relief (BNI grade Ⅳ-Ⅴ), and 22 (10.19%) recurred TN in 216 cases of the younger group; 35 cases (79.55%) had complete pain relief (BNI gradeⅠ), 2 cases (4.55%) had partial pain relief (BNI grade Ⅱ-Ⅲ), one case (2.27%) had no pain relief (BNI grade Ⅳ- Ⅴ), and 6 cases (13.64% ) recurred TN in 44 cases of the older group. There was no significant difference on prognosis between 2 groups (χ2 = 1.530, P = 0.675). Kaplan-Meier curve showed the rate of complete pain relief was decreased with time. Conclusions Pure MVD for treating elderly patients with TN is safe and effective, without postoperative death or severe complications.

Objective To explore the reference value in anterior approach penetrate foramen rotundum with the subzygomatic and suborbital connecting line. Methods 24 patients with primary trigeminal neuralgia were admitted in The First People's Hospital of Nantong from January 2017 to December 2018, who were randomly divided into two groups. Group A: The subzygomatic and suborbital connecting line was marked on the face before operation and punctured according to the marked reference line. The pterygopalatine fossa was punctured first, then the direction was adjusted to enter the foramen rotundum. Group B: There was no facial reference line. The puncture needle slided into the pterygopalatine fossa along the posterior lateral wall of the maxilla. The direction of puncture was gradually adjusted with the X-ray photography and into the foramen rotundum. Preoperative pain score ( VAS ), operation time, puncture times, intraoperative puncture complications, first attempt accuracy rate, effective rate and numbness rate of upper lip and palate in postoperation of the two groups were analyzed. Meanwhile, the reference line was evaluated if仆 was consistent 飞vith between the subzygomatic suborbital line and the direction of puncture needle in group A. Results All 24 patients completed to puncture the foramen rotundum through the anterior approach without major complications. The effective rate of the postoperative and the numbness rate of postoperative upper lip and palate were 100% of two groups. There were 6 cases with facial hematoma in B group. Compared operation time, puncture times, first attempt accuracy rate, there were significant statistical differences (P < 0. 05 ) . The line between subzygomatic and suborbital was consistent with the direction of puncture needle, the average angle was ( 0. 63 土 2 . 82 ) 0 . Conclusion It is feasible of puncturing punctur ng foramen rotund um to treat trigeminal neuralgia, between subzygomatic and suborbital connecting line is of good reference value for the operation through the anterior approach, which can reduce complications, operation time, puncture times and be worthy of promotion . [ABSTRACT FROM AUTHOR]

Objective: To study the evaluation value of functional magnetic resonance imaging (fMRI) in brain function of patients with idiopathic trigeminal neuralgia (ITN) and the clinical significance of serum interleukin-1β(IL-1β) and tumor necrosis factor-α (TNF-α). Methods: A total of 50 patients with ITN who were treated in Stomatological Hospital Affiliated to Anhui Medical University from February 2017 to February 2019 were included in the study and recorded as ITN group. Another 50 healthy patients who received physical examination during the same period were recorded as healthy control group. Both groups were scanned by fMRI at rest. The levels of mean fractional amplitude of low frequency fluctuation (mfALFF), serumIL-1βand TNF-α in the two groups were compared. Results: The levels of mfALFF in the left middle occipital gyrus, inferior occipital gyrus, fusiformgyrus, calcinate fissure surrounding cortex, central paralateral gyrus, triangular inferior frontal gyrus, right dorsolateral superior frontal gyrus and left cerebellar region 1 in the ITN group were higher than those in the healthy control group (all P<0.05). In the ITN group, the mfALFF values of right superior temporal gyrus, right middle temporal gyrus, right inferior temporal gyrus, right central sulcus cover, right superior marginal gyrus, right inferior temporal gyrus, left anterior cingulate gyrus, paracingulate gyrus, left temporal polar and superior temporal gyrus were significantly lower than those in the healthy control group (all P<0.05). The levels of serumIL-1β and TNF-α in the ITN group were higher than those in the healthy control group (all P<0.05). Conclusion: The evaluation value of fMRI at brain function in resting state of patients with ITN is high. The elevated levels of serum IL-1βand TNF-α may be closely related to the pathogenesis of ITN, and it play a role in promoting the occurrence and development of the disease. [ABSTRACT FROM AUTHOR]

Objective To explore the contributing factors of the long-term effectiveness of microvascular decompression（MVD） for classical trigeminal neuralgia（TN） to improve the efficacy of MVD. Methods The clinical data of 99 patients with TN who underwent MVD treatment from January 2014 to November 2019 in the Department of Neurosurgery, the Affiliated Brain Hospital of Nanjing Medical University were analyzed retrospectively. The postoperative efficacy was followed up through outpatient and telephone ask. A single factor analysis was used to analyze the relationship between each factor and the effectiveness, and relevant factors were screened out, then they were used in the Cox regression models to analyze the contributing factors of postoperative efficacy. Results Eighty-six were completely painless(BNI I) after surgery, and immediate remission rate was 86.9%. Kaplan-Meier survival analysis showed that the pain relief rates of TN patients at 1 year, 3 years, and 5 years were 86.7%, 73.9%, and 70.7%, respectively. Multivariate Cox regression analysis showed that age≥60 years（P=0.03）, duration<5 years（P=0.011）, arterial compression（vein＆ artery vs pure artery P=0.006, pure vein vs pure artery P=0.007）and typical TN（P=0.02）were independent predictors of good long-term outcomes. Conclusions Patients receiving MVD can obtain satisfactory results. The disease course, age, culprit vessels, and clinical presentation have certain effects on the long-term efficacy of MVD. [ABSTRACT FROM AUTHOR]

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Objective: To explore the clinical effect of Microvascular decompression (MVD) in the treatment of patients with Trigeminal neuralgia (fN). Methods: A retrospective analysis of patients with TN treated with MVD in our department from January 2014 to January 2015 was conducted, to investigate the prognosis and prognostic factors. Results: 120 cases of patients with TN were selected, including 13 patients with simple venous compression, 60 patients with simple arterial compression, and 46 patients with mixed compression. The remission rates of patients with simple venous compression at 1 day, 3 months, 1 year, and 3 years after surgery were 84.6%, 7 6.9%, 69.2% and 61.5%, and those with simple arterial compression were 88.3 %, 8 5.0%, 83.3% and 7 0.0%, the patients with mixed compression were 93.5%, 93.5%, 91.3% and 87.0%, respectively. The remission rate of patients in group A was lower than that in group Cat 1 year and 3 years after MVD (P<0.05). There was no significant difference in the remission rate between group A and group B, group B and group Cat 1 day, 3 months and 1 year after surgery (P>0.05), but the remission rate in group C was significantly higher than that in group B after 3 years (P<0.05). Conclusions: The remission rate of MVD in TN patients with simple venous compression is lower than that in patients with arterial compression and mixed compression, patients with mixed compression have the highest long-term remission rate. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Clinical Healthcare is the property of Chinese Journal of Clinical Healthcare and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

DOI: 10.3969/j.issn.1672-6731.2018.10.009

Trigeminal neuralgia is a manifestation of orofacial neuropathic pain disorder, always deemed to be an insurmountable peak in the field of pain research and treatment. The pain is recurrent, abrupt in onset and termination similar to an electric shock or described as shooting. A poor quality of life has been attributed to trigeminal neuralgia, as the paroxysms of pain may be triggered by innocuous stimuli on the face or inside the oral cavity, such as talking, washing face, chewing and brushing teeth in daily life. The pathogenesis of trigeminal neuralgia has not been fully elucidated, although the microvascular compression in the trigeminal root entry zone is generally considered to be involved in the emergence and progression of the pain disorder. In addition, orofacial neuropathic pain restricted to one or more divisions of the trigeminal nerve might be secondary to peripheral nerve injury. Based on current hypotheses regarding the potential causes, a variety of animal models have been designed to simulate the pathogenesis of trigeminal neuralgia, including models of compression applied to the trigeminal nerve root or trigeminal ganglion, chronic peripheral nerve injury, peripheral inflammatory pain and center-induced pain. However, it has not yet been possible to determine which model can be perfectly employed to explain the mechanisms. The selection of appropriate animal models is of great significance for the study of trigeminal neuralgia. Therefore, it is necessary to discuss the characteristics of the animal models in terms of animal strains, materials, operation methods and behavior observation, in order to gain insight into the research progress in animal models of trigeminal neuralgia. In the future, animal models that closely resemble the features of human trigeminal neuralgia pathogenesis need to be developed, with the aim of making valuable contributions to the relevant basic and translational medical research.

Objectives: Trigeminal neuralgia (TN) is a common neuropathic pain. Voltage-gated potassium channel (Kv) has been confirmed to be involved in the occurrence and development of TN, but the specific mechanism is still unclear. MicroRNA may be involved in neuropathic pain by regulating the expression of Kv channels and neuronal excitability in trigeminal ganglion (TG). This study aims to explore the relationship between Kv1.1 and miR-21-5p in TG with a TN model, evaluate whether miR-21-5p has a regulatory effect on Kv1.1, and to provide a new target and experimental basis for the treatment of TN., Methods: A total of 48 SD rats were randomly divided into 6 groups: 1) a sham group ( n =12), the rats were only sutured at the surgical incision without nerve ligation; 2) a sham+agomir NC group ( n =6), the sham rats were microinjected with agomir NC through stereotactic brain injection in the surgical side of TG; 3) a sham+ miR-21-5p agomir group ( n =6), the sham rats were microinjected with miR-21-5p agomir via stereotactic brain injection in the surgical side of TG; 4) a TN group ( n =12), a TN rat model was constructed using the chronic constriction injury of the distal infraorbital nerve (dIoN-CCI) method with chromium intestinal thread; 5) a TN+antagonist NC group ( n =6), TN rats were microinjected with antagonist NC through stereotactic brain injection method in the surgical side of TG; 6) a TN+ miR-21-5p antagonist group ( n =6), TN rats were microinjected with miR-21-5p antagonist through stereotactic brain injection in the surgical side of TG. The change of mechanical pain threshold in rats of each group after surgery was detected. The expressions of Kv1.1 and miR-21-5p in the operative TG of rats were detected by Western blotting and real-time reverse transcription polymerase chain reaction. Dual luciferase reporter genes were used to determine whether there was a target relationship between Kv1.1 and miR-21-5p and whether miR-21-5p directly affected the 3'-UTR terminal of KCNA1 . The effect of brain stereotaxic injection was evaluated by immunofluorescence assay, and then the analogue of miR-21-5p (agomir) and agomir NC were injected into the TG of rats in the sham group by brain stereotaxic apparatus to overexpress miR-21-5p . The miR-21-5p inhibitor (antagomir) and antagomir NC were injected into TG of rats in the TN group to inhibit the expression of miR-21-5p . The behavioral changes of rats before and after administration were observed, and the expression changes of miR-21-5p and Kv1.1 in TG of rats after intervention were detected., Results: Compared with the baseline pain threshold, the facial mechanical pain threshold of rats in the TN group was significantly decreased from the 5th to 15th day after the surgery ( P <0.05), and the facial mechanical pain threshold of rats in the sham group was stable at the normal level, which proved that the dIoN-CCI model was successfully constructed. Compared with the sham group, the expression of Kv1.1 mRNA and protein in TG of the TN group was down-regulated (both P <0.05), and the expression of miR-21-5p was up-regulated ( P <0.05). The results of dual luciferase report showed that the luciferase activity of rno- miR-21-5p mimics and KCNA1 WT transfected with 6 nmol/L or 20 nmol/L were significantly decreased compared with those transfected with mimic NC and wild-type KCNA1 WT, respectively ( P <0.001). Compared with low dose rno- miR-21-5p mimics (6 nmol/L) co-transfection group, the relative activity of luciferase in the high dose rno- miR-21-5p mimics (20 nmol/L) cotransfection group was significantly decreased ( P <0.001). The results of immunofluorescence showed that drugs were accurately injected into TG through stereotaxic brain. After the expression of miR-21-5p in the TN group, the mechanical pain threshold and the expression of Kv1.1 mRNA and protein in TG were increased. After overexpression of miR-21-5p in the sham group, the mechanical pain threshold and the expression of Kv1.1 mRNA and protein in TG were decreased., Conclusions: Both Kv1.1 and miR-21-5p are involved in TN and miR-21-5p can regulate Kv1.1 expression by binding to the 3'-UTR of KCNA1.

Objectives: Trigeminal neuralgia (TN) is a severe chronic neuropathic pain that mainly affects the distribution area of the trigeminal nerve with limited treating efficacy. There are numerous treatments for TN, but currently the main clinical approach is to suppress pain by carbamazepine (CBZ). Brain-derived neurotrophic factor (BDNF) is closely related to chronic pain. This study aims to determine the effects of CBZ treatment on BDNF expression in both the trigeminal ganglion (TG) and serum of TN via a chronic constriction injury of the infraorbital nerve (ION-CCI) rat model., Methods: The ION-CCI models were established in male Sprague-Dawley rats and were randomly divided into a sham group, a TN group, a TN+low-dose CBZ treatment group (TN+20 mg/kg CBZ group), a TN+medium-dose CBZ treatment group (TN+40 mg/kg CBZ group), and a TN+high-dose CBZ treatment group (TN+80 mg/kg CBZ group). The mechanical pain threshold in each group of rats was measured regularly before and after surgery. The expressions of BDNF and tyrosine kinase receptor B ( TrkB ) mRNA in TGs of rats in different groups were determined by real-time PCR, and the expression of BDNF protein on neurons in TGs was observed by immunofluorescence. Western Blotting was used to detect the protein expression of BDNF, TrkB, extracellular regulated protein kinases (ERK), and phospho-extracellular regulated protein kinases (p-ERK) in TGs of rats in different groups. The expression of BDNF in the serum of rats in different groups was detected by enzyme-linked immunosorbent assay (ELISA)., Results: The results of mechanical pain sensitivity showed that there was no significant difference in the mechanical pain threshold in the right facial sensory area of the experimental rats in each group before surgery (all P >0.05). From the 3rd day after operation, the mechanical pain threshold of rats in the TN group was significantly lower than that in the sham group (all P <0.01), and the mechanical pain threshold of rats in the TN+80 mg/kg CBZ group, the TN+40 mg/kg CBZ group, and the TN+20 CBZ mg/kg group was higher than that in the TN group (all P <0.05). The BDNF and TrkB mRNA and protein expressions in TGs of rats in the TN group were higher than those in the sham group (all P <0.05), and those in the TN+80 mg/kg CBZ group, the TN+40 mg/kg CBZ group, and the TN+20 mg/kg CBZ group were lower than the TN group (all P <0.05). The p-ERK levels in TG of rats in the TN+80 mg/kg CBZ group, the TN+40 mg/kg CBZ group, and the TN+20 mg/kg CBZ group were significantly decreased compared with the TN group (all P <0.05). The BDNF and neuron-specific nuclear protein (NeuN) were mainly co-expressed in neuron of TGs in the TN group and they were significantly higher than those in the sham group (all P <0.05). The co-labeled expressions of BDNF and NeuN in TGs of the TN+ 80 mg/kg CBZ group, the TN+40 mg/kg CBZ group, and the TN+20 mg/kg CBZ group were lower than those in the TN group (all P <0.05). The results of ELISA showed that the level of BDNF in the serum of the TN group was significantly higher than that in the sham group ( P <0.05). The levels of BDNF in the TN+80 mg/kg CBZ group, the TN+40 mg/kg CBZ group, and the TN+20 mg/kg CBZ group were lower than those in the TN group (all P <0.05). Spearman correlation analysis showed that the BDNF level in serum was negatively correlated with mechanical pain threshold ( r =-0.650, P <0.01)., Conclusions: CBZ treatment can inhibit the expression of BDNF and TrkB in the TGs of TN rats, reduce the level of BDNF in serum of TN rats and the phosphorylation of ERK signaling pathway, so as to inhibit TN. The serum level of BDNF can be considered as an indicator for the diagnosis and prognosis of TN.

Objectives: The activation of astrocytes is an important process in the formation of chronic pain. This study aims to observe the activation of A1 reactive astrocytes in the medullary dorsal horn in the rat model of trigeminal neuralgia, and to explore the mechanism of central sensitization caused by A1 reactive astrocyte., Methods: The adult male rats were randomly divided into a sham group and a chronic constriction injury of infraorbital nerve (ION-CCI) group. The facial mechanical pain threshold and thermal withdrawal latency were measured before the operation and on the 1st, 3rd, 7th, 10th, and 14th day after the operation. After pain behavior observation, the expression of glial fibrillary acidic protein (GFAP) in the medullary dorsal horn was observed by immunohistochemistry and immunofluorescence colocalization of GFAP, complement 3 (C3)/S100A10, and 4', 6-diamidino-2-phenylindole (DAPI) was analyzed. Primary astrocytes were cultured and randomly divided into a naive group and a DHK group. The DHK group was treated with 1 mmol/L of astrocyte activation inhibitor dihydrokainic acid (DHK). Fura-2/AM was used to stain the astrocytes and the calcium wave of the 2 groups under the stimulation of high potassium was recorded and compared. The expression of C3 was detected by Western blotting., Results: The facial mechanical pain threshold and thermal withdrawal latency of the ION-CCI group were significantly lower than those of the sham group (both P <0.05). There were a large number of GFAP positive astrocytes in the medullary dorsal horn of the ION-CCI group. The fluorescence intensity of GFAP in the ION-CCI group was higher than that in the sham group ( P <0.05). GFAP and C3/S100A10 were co-expressed in astrocytes. Compared with the sham group, the fluorescence intensity of C3 and the protein expression of C3 in the ION-CCI group were increased (both P <0.05). The expression of C3 in ION-CCI group was significantly increased ( P <0.05). Compared with the naive group, the C3 protein expression was significantly decreased in the DHK group ( P <0.05). The intensity of calcium fluorescence was increased after high potassium stimulation in both groups. Furthermore, the peak and increase amplitude of calcium fluorescence in the naive group were much higher than those in the DHK group (both P <0.05)., Conclusions: A1 reactive astrocytes in the medullary dorsal horn of trigeminal neuralgia model rats are increased significantly, which may participate in central sensitization of trigeminal neuralgia by impacting astrocyte calcium wave.

Secondary trigeminal neuralgia after brainstem infarction is rare and rarely reported. A patient with secondary trigeminal neuralgia after brainstem infarction was admitted to the Department of Neurosurgery, Xiangya Hospital, Central South University. The patient was a 44 years old male who underwent motor cortex stimulation treatment after admission. The effect was satisfactory in the first week after surgery, but the effect was not satisfactory after one week. This disease is relatively rare and the choice of clinical treatment still requires long-term observation.

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ObjectiveTo discuss the management of superior petrosal vein and the influence of complications during trigeminal nerve microvascular decompression（MVD）. MethodsThe clinical data of 200 patients with trigeminal neuralgia treated by MVD from June 1, 2012 to May 30, 2013 in Jining First People's Hospital of Shandong Province were analyzed retrospectively. Results Of 200 patients, the complications were counted according to the management of superior petrosal vein during operation. 2 cases were cut off the main trunk of superior petrosal vein during operation, including 1 of cerebellar edema and 1 of brainstem infarction. The branches of superior petrosal vein were cut off in 17 cases during operation, including 1 of cerebellar hemorrhage and 181 of complete protection of superior petrosal vein during operation. According to the compression of the responsible vessels of trigeminal nerve during operation, 4 were simple venous compression, while 58 were arterial compression coexist with superior petrosal vein, and 138 were simple arterial compression. ConclusionsDifferent types of superior petrosal veins should be treated in different ways according to the actual situation during the operation. Retaining the superior petrosal veins, especially to sharp separation of the double-layer structure of the arachnoid of the superior petrosal veins adequately can greatly reduce the incidence of postoperative complications. [ABSTRACT FROM AUTHOR]

Objective To investigate the application of neuroendoscopy and curative effect of lateral skull base surgery via transcranial approach. Methods Clinical data of 142 cases undergoing endoscopic lateral skull base surgeries via transcranial approach from July 2015 to July 2018 were retrospectively analyzed. There were 32 cases of primary hemifacial spasm, 56 cases of primary trigeminal neuralgia, 2 cases of primary glossopharyngeal neuralgia, 15 cases of epidermoid cyst, 14 cases of acoustic neuroma, 3 cases of trigeminal schwannoma, 18 cases of pontocerebellar trigone meningioma, and 2 cases of jugular foramen schwannoma. Among them, 90 cases (32 cases of primary hemifacial spasm, 56 cases of primary trigeminal neuralgia and 2 cases of primary glossopharyngeal neuralgia) underwent endoscopic microvascular decompression (MVD) via transcranial approach, and 52 cases (15 cases of epidermoid cyst, 14 cases of acoustic neuroma, 3 cases of trigeminal schwannoma, 18 cases of pontocerebellar trigone meningioma, and 2 cases of jugular foramen schwannoma) underwent endoscopic removal of lateral skull base tumors via transcranial approach. Results All the operations were performed under endoscopy, including 96 cases (67.61%) operated by single hand (the endoscope was held by a pneumatic arm) and the rest 46 cases (32.39%) operated by both hands. The cure rate of MVD was 87.78% (79/90) and the total removal rate of lateral skull base tumors was 90.38% (47/52). The mean follow - up period was (23.46 ± 8.93) months. There was no death or other serious complications. Conclusions The complex lateral skull base surgery via transcranial approach can be performed by neuroendoscope with pneumatic endoscopic fixed arm. It has the advantages of near and multi - angle observation, clear visual field, full exposure and high recognition of nerve and blood vessels. However, the requirements for endoscopic technology, instruments and assistive equipments are high, and it is necessary to receive relevant trainings and experiences in endoscopic surgery. [ABSTRACT FROM AUTHOR]

Objective: To analyze the application effect of oxycodone combined with dexmedetomidine on the trigeminal nerve microvascular decompression. Methods: 86 cases of trigeminal neuralgia who were treated from January 2015 to June 2016 in our hospital were selected and divided into the control group and research group with 43 cases in each group according to the random table method. The control group was treated with oxycodone anesthesia, while the research group was treated with oxycodone jiont dexmeidine. Then the blood pressure, mean arterial pressure, serum interleukin-8(IL-8), c-reactive protein(CRP), and tumor necrosis factor-α(TNF-α) levels before and after the surgery, clinical efficacy, recurrence and adverse reactions were compared between two group. Results: Before surgery, the blood pressure, mean arterial pressure, serum IL-8, CRP, TNF-αshowed no statistically significant difference between the two groups(P>0.05). After surgery, the blood pressure, mean arterial pressure, serum IL-8, CRP, TNF-α in both groups were decreased than those before surgery and the blood pressure, mean arterial pressure of research group were higher than those of the control group, but the serum IL-8, CRP, TNF-αlevels of research group were lower than those of the control group(P<0.05). The excellent rate, recurrence rate of two groups showed no significant difference(P>0.05). There were bradycardia, itching, dizziness,nausea and vomiting in both groups, but the adverse reaction rate in research group was significantly lower than that of the study group(P<0.05). Conclusion: Oxycodone dexmedetomidine was effective in trigeminal nerve microvascular decompression, which could significantly reduce the inflammatory response and relieve the pain. [ABSTRACT FROM AUTHOR]

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Objective: To analyze the application and prognosis of microvascular decompression in patients with trigeminal neuralgia. Methods: From August 2015 to July 2016, 86 patients with trigeminal neuralgia were selected in our hospital, those patients were divided into observation group(43 cases) and control group(43 cases) according to the order of admission. The control group was given radiofrequency thermocoagulation treatment of trigeminal ganglion, the observation group using microvascular decompression to complete the treatment. Comparison of two groups of patients with clinical efficacy, surgical conditions, complications and recurrence. Results:After treatment, the total effective rate of the observation group was significantly higher than that of the control group [93.02%(40/43) vs72.09%(31/43)](P<0.05). Visual analog scale(VAS) and Pittsburgh Sleep Quality Index Scale(PSQI) in the observation group were significantly lower than those in the control group [(3.35±0.31) points,(7.02±0.81) points vs(5.68±0.57) points(8.45±0.92) points](P<0.05). The quality of life score of the observation group was significantly higher than that of the control group [(83.43±8.22) points vs(68.98±6.51)points](P<0.05). Conclusion: Treatment of patients with trigeminal neuralgia by microvascular decompression can reduce the degree of pain in patients, and improve the quality of sleep and quality of life is conducive to improving the prognosis of patients. [ABSTRACT FROM AUTHOR]

Objective To investigate the influence of the number of offending vessels on clinical efficacy and safety of microvascular decompression (MVD) in the treatment of trigeminal neuralgia (TN). Methods A total of 80 idiopathic TN patients underwent MVD were divided into 2 groups: single offending vessel group (N = 48) and multiple offending vessels group (N = 32). Visual Analogue Scale (VAS) was used to evaluate the degree of pain before and after surgery. Brisman Standard was used to evaluate curative effect and calculate total effective rate. Postoperative complications (fever, angular numbness, hearing loss, transient trochlear nerve palsy, swelling of incision) and recurrence rate one year after MVD were recorded. Results The VAS scores of 2 groups after operation were significantly lower than before operation (F = 5.871, P = 0.000). There was no significant difference on VAS scores between 2 groups (F = 1.192, P = 0.318). In 48 patients of single offending vessel group, 40 cases (83.33%) were cured, 4 cases (8.33%) had obvious effect, 2 cases (4.17%) were improved and 2 cases (4.17%) had no effect. The total effective rate was 95.83% (46/48). Seven cases (14.58%) presented postoperative complications, including fever in 4 cases (8.33%), angular numbness in one case (2.08%), transient trochlear nerve palsy in 2 cases (4.17%). TN recurred in 2 cases (4.17%). In 32 patients of multiple offending vessels group, 27 cases (84.38%) were cured, 3 cases (9.38%) had obvious effect, one case (3.13%) was improved and one case (3.13% ) had no effect. The total effective rate was 96.88% (31/32). Six cases presented postoperative complications, including fever in 4 cases (12.50%), hearing loss in one case (3.13%), swelling of incision in one case (3.13%). TN recurred in 2 cases (6.25%). There were no significant differences in total effective rate (x2 = 1.863, P = 0.485), incidence of postoperative complication (X² = 2.119, P = 0.378) and postoperative recurrence rate (adjusted X² = 2.075, P = 0.391) between 2 groups. Conclusions MVD has similar clinical effects and safety in the treatment of TN patients with single or multiple offending vessels. [ABSTRACT FROM AUTHOR]

Objective To compare the efficacy and safety of microvascular decompression (MVD) and non-surgical treatment for treating senile idiopathic trigeminal neuralgia (ITN). Methods A total of 133 patients older than 75 years with ITN respectively received MVD (N = 80) and non-surgical treatments (N = 53) such as pulse radiofrequency in 38 cases, stereotactic gamma knife radiotherapy in 10 cases, and acupuncture and moxibustion in 5 cases. McGill Pain Questionnaire (MPQ) was used to evaluate the degree of pain improvement. World Health Organization Quality of Life Scale-100 (WHOQoL-100) was used to evaluate life quality. Postoperative complications were recorded, including facial blunt sensation, headache, nausea and vomiting, pneumonia, intracranial infection, cerebrospinal fluid (CSF) leakage, deep venous thrombosis, incomplete facial paralysis, hearing loss and dyskinesia. Results In MVD group, 79 cases (98.75%) had complete pain relief and one case (1.25%) had partial pain relief after operation. There were 8 cases (15.09% ) with complete pain relief, 33 cases (62.26% ) with partial pain relief, and 12 cases (22.64% ) without pain relief in non -surgical treatment group. The difference between 2 groups was statistically significant (X²2 = 84.241, P = 0.000). After 55.80 (35.74, 63.48) months follow-up, the recurrence rate of MVD group was significantly lower than that of non - surgical treatment group [8.75% (7/80) vs. 35.85% (19/53); X² = 16.558, P = 0.000]. The life quality of MVD group was better than that of non-surgical treatment group [WHOQoL - 100 (27.82 ± 2.10) score vs. (22.19 ± 7.22) score; t = 1.202, P = 0.039]. The occurrence of postoperative complications such as facial blunt sensation, headache, nausea and vomiting were high in both groups, while the occurrence of pneumonia, intracranial infection, CSF leakage, deep venous thrombosis, incomplete facial paralysis, hearing loss and dyskinesia were rare in both groups. No case was dead. The incidence of facial blunt sensation in MVD group was significantly lower than that in non - surgical treatment group [8.75% (7/80) vs. 86.79% (46/53); X² = 81.005, P = 0.000]. Conclusions MVD is safe and effective in the treatment of senile ITN, so it is suggested that MVD should be the first choice for patients with ITN, unless they cannot tolerate general anesthesia. [ABSTRACT FROM AUTHOR]

Objective To analyze the efficacy and safety of pure microvascular decompression (MVD) for trigeminal neuralgia (TN), and to screen related risk factors for TN recurrence. Methods A total of 286 primary TN patients underwent pure MVD. Barrow Neurological Institute (BNI) grade was used to evaluate the relief of TN before and after surgery and during the follow-up. Postoperative complications were recorded, including facial numbness of operation side, hearing loss of operation side, cerebrospinal fluid (CSF) leakage, poor wound healing, intracranial infection and hydrocephalus. The recurrence during follow-up was also recorded. Univariate and multivariate forward Logistic regression analysis were used to screen related risk factors of recurrent TN. Results Of all patients, 18 cases (6.29%) had slight facial numbness of operation side after surgery, 13 cases (4.55% ) had hearing loss of operation side after operation. One (0.35%) had CSF leakage, and was cured after lumbar cistern drainage. One (0.35%) had no wound healing, and was cured after bone wax and repairing titanium mesh were removed in the reoperation. Two cases (0.70% ) had intracranial infection and were cured by antibiotic therapy. One (0.35%) had hydrocephalus and was cured after external ventricular drainage. Of 286 patients, 26 cases (9.09%) were lost during the follow-up, 13 cases (4.55%) had no pain relief after surgery, 13 cases (4.55%) had partial pain relief after surgery and 234 cases (81.82%) had complete pain relief after surgery. The follow-up period of 234 cases was a mean of 31.29 months. During follow-up, one case (0.35%) died of heart disease, and 28 cases (9.79%) had pain recurrence. Kaplan-Meier curve showed the rate of complete pain relief was decreased with time, the recurrence rate was 5.4% one year after surgery, 15.2% 3 years after surgery, and 21.2% 5 years after surgery. Univariate and multivariate forward Logistic regression analysis showed preoperative BNI grade - was independent risk factor for recurrence of TN (OR = 2.385, 95%CI: 1.063-5.353; P = 0.035). Conclusions Pure MVD for treating TN is safe and effective, without postoperative death or severe complications. [ABSTRACT FROM AUTHOR]

Objective To summarize the surgical experience of microvascular decompression(MVD) for trigeminal neuralgia(TN) and hemifacial spasm(HFS) and investigate the efficacy and complications. Methods 20 patients with TN and HFS treated with MVD from April 2011 to June2018 were respectively analyzed and evaluated from the following perspectives: craniotomy, protection of nerves and vessels, identification of the compressing vessels, surgical strategy, curative effect and complications. Results The early total cure rate was 95%. 8 cases of TN were cured. 10 cases of HFS were healed instantly. 1 HFS was delayed healed. 1 HFS was delayed improved. 1 patient had severe complications. 3 patients had mild complications. Surgical strategy correlated with curative effect and complications. Conclusion MVD is an effective treatment for the patients with TN and HFS, individualized surgical strategy is significant to the efficacy and complications. [ABSTRACT FROM AUTHOR]

Objective To investigate the significance of preoperative imaging of trigeminal neuralgia and curative effect of microvascular decompression(MVD). Methods The clinical data of83 patients with primary trigeminal neuralgia treated by MVD from January 2014 to December 2016 in Affiliated Hospital of Xuzhou Medical University were analyzed retrospectively. Results 83 cases with primary trigeminal neuralgia by magnetic resonance tomography angiography(MITA) showed close relationship between the trigeminal nerve and peripheral blood vessels in 75 cases, including the trigeminal nerve with the small artery in 71 cases, blood vessels ride 4 and tortuous basilar artery in 1.The examination positive rate was 90.4%, 93.6% in sensitivity, 75.0% in specificity and the correct rate was 92.6%. Patients with primary trigeminal neuralgia were followed up for 12 to 36 months(mean 22 ±2.5 months), postoperative early(after 3 months) the cure rate was as high as 81.9%, the effective rate was 92.8%, postoperative late(after 12 months) the cure rate was as high as 87.5%, the effective rate was 94.8%, the effect was significant. Conclusions Magnetic resonance tomography angiography is not only helpful for the diagnosis of secondary causes of trigeminal neuralgia, but also for the responsible vessel of compression of primary trigeminal neuralgia, which is of great significance for surgical guidance. MVD is currently an effective treatment for trigeminal neuralgia. [ABSTRACT FROM AUTHOR]

Objective To analyze the efficacy and safety of microvascular decompression (MVD) for the treatment of elderly patients with trigeminal neuralgia (TN). Methods A total of 286 primary TN patients [50 cases of age ≥ 70 years (older group) and 236 cases of age < 70 years (younger group)] underwent MVD via suboccipital sigmoid approach. Postoperative complications were recorded, including facial numbness of operation side, hearing loss of operation side, cerebrospinal fluid (CSF) leakage, poor wound healing, intracranial infection and hydrocephalus. Barrow Neurological Institute (BNI) grade was used to evaluate the relief of TN before and after surgery and during the follow-up. The recurrence rate during follow-up period was recorded. Results Of all cases, 36 (12.59%) presented with postoperative complications, including 18 cases (6.29%) of facial numbness of operation side, 13 cases (4.55%) of hearing loss of operation side, one case (0.35%) of CSF leakage, one case (0.35%) of poor wound healing, 2 cases (0.70%) of intracranial infection and one case (0.35%) of hydrocephalus. In those 36 cases, 29 cases (12.29%) were in younger group and 7 cases (14%) were in older group, and there was no significant difference between 2 groups (χ² = 0.110, P = 0.740). The mean follow-up period was 29.43 months. During the follow-up, 170 cases (78.70%) had complete pain relief (BNI grade I), 10 cases (4.63%) had partial pain relief (BNI grade I-III), 14 cases (6.48%) had no pain relief (BNI grade IV-V), and 22 (10.19%) recurred TN in 216 cases of the younger group; 35 cases (79.55%) had complete pain relief (BNI grade I ), 2 cases (4.55%) had partial pain relief (BNI grade II-III), one case (2.27%) had no pain relief (BNI grade IV-V), and 6 cases (13.64%) recurred TN in 44 cases of the older group. There was no significant difference on prognosis between 2 groups (χ² = 1.530, P = 0.675). Kaplan-Meier curve showed the rate of complete pain relief was decreased with time. Conclusions Pure MVD for treating elderly patients with TN is safe and effective, without postoperative death or severe complications. [ABSTRACT FROM AUTHOR]

Objective To explore clinical features and surgical outcome of primary and secondary trigeminal neuralgia (TN). Methods A total of 105 cases of TN, including 90 primary and 15 secondary TN cases, were treated with microvascular decompression (MVD) or primary lesion resection and trigeminal nerve detection followed by necessary MVD, respectively. The postoperative effect and neurological complications (including hearing loss, symptomatic ischemic stroke and facial nerve injury) were evaluated. Results Of all 90 cases of primary TN, 85 cases underwent MVD via suboccipital retrosigmoid approach (85 cases, 100%), offending vessels were detected in 81 cases (95.29%), neuralgia was relieved in 84 cases (98.82%) after surgery, and neurological complications were detected in one case (1.18%) manifested as hearing loss. Of 15 cases of secondary TN, primary lesions were resected with surrounding vessels exploration [12 cases (12/15) through suboccipital retrosigmoid approach and 3 cases (3/15) through infratemporal tentorial approach]. Primary lesion resection and trigeminal nerve detection were applied followed by necessary MVD. Offending vessels were detected in 3 cases (3/15), all 15 cases (15/15) had neuralgia relieved, and 7 cases (7/15) had neurological complications in secondary TN, including hearing loss in 5 cases, symptomatic ischemic stroke in one case, and facial nerve injury in 6 cases. Postoperative pathological examination showed acoustic neuroma in 5 cases (5/15), epidermoid cyst in 4 cases (4/15), endothelioid meningioma (WHO I) in 2 cases (2/15), transitional meningioma (WHO I) in 2 cases (2/15) and cerebellar arteriovenous malformation in one case (1/15). One case (1/15) with arachnoid cyst did not perform pathological examination. In the primary TN cases, the age at initial symptom onset was older [(51.61 ± 12.21) years vs. (44.87 ± 11.87) years; t = 1.988, P = 0.049], the ratio of cases with preoperative hearing loss was lower [0 (0/90) vs. 7/15; adjusted χ² = 37.813, P = 0.000], the ratio of surgeries through suboccipital retrosigmoid approach was higher [100% (85/85) vs. 12/15; adjusted χ² = 11.327, P = 0.001], the ratio of offending vessels detected during surgery was higher [95.29% (81/85) vs. 3/15; adjusted χ² = 48.325, P = 0.000], the ratio of postoperative complications was lower [1.18% (1/85) vs. 7/15; adjusted χ² = 29.934, P = 0.000] than those in secondary TN cases, respectively. Conclusions Differences are noted in clinical features between primary and secondary TN. Hearing loss considering as early symptom may suggest primary lesion in secondary TN. Appropriate surgical approach should be selected for surgery according to specific lesions. During surgery, all surrounding vessels of cisternal segment of trigeminal nerve should be explored to achieve sufficient decompression of trigeminal nerve. The rate of pain relief after operation is high in both primary and secondary TN, while neurological complications may occur in secondary TN after surgery. [ABSTRACT FROM AUTHOR]

Objective To evaluate the changes of pain and sensory function in patients with idiopathic trigeminal neuralgia (ITN) treated by adriamycin interventional treatment, and to explore their correlation. Methods A total of 23 patients with ITN were treated by adriamycin interventional treatment guided via CT. Visual Analogue Scale (VAS) was used to evaluate the degree of pain before treatment and 1 d, 7 d, 1 month, 3 months, 6 months, 12 months after treatment. Quantitative Sensory Testing (QST) was used to measure cold sensation (CS), warm sensation (WS), cold pain (CP) and hot pain (HP) threshold value of chin at the affected side. Results Compared with before treatment, VAS scores decreased at 1 d, 7 d, 1 month, 3 months, 6 months and 12 months after treatment (P = 0.000, for all). One month, 3 months, 6 months and 12 months after treatment, CS (P = 0.003, 0.000, 0.000, 0.000) and CP (P = 0.022, 0.000, 0.000, 0.013) decreased, while WS (P = 0.004, 0.002, 0.000, 0.000) and HP (P = 0.004, 0.002, 0.000, 0.000) increased. Pearson correlation analysis showed VAS scores were positively correlated with CS (r = 0.703, P = 0.000) and CP (r = 0.679, P = 0.002), and negatively correlated with WS (r = -0.782, P = 0.000) and HP (r = -0.726, P = 0.001) after adriamycin interventional treatment. Conclusions QST was confirmed as noninvasive, simple and objective measurement. It could be used to quantificationally analyze the damage of sensory nervous function and could be a valuable index in evaluating the curative effect of trigeminal nerve destruction. [ABSTRACT FROM AUTHOR]