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Background: The degree of cervical extension required during percutaneous balloon compression (PBC) of the Gasserian ganglion for trigeminal neuralgia (TN) varies among patients, but the traditional operating tables often fail to fulfil each patient's individual requirements., Objective: This study aimed to compare the clinical efficacy of an extended operating table to that of a traditional operating table in C-arm-guided PBC of the Gasserian ganglion for TN., Study Design: This is a consecutively prospective comparative study., Setting: Fujian Provincial Hospital., Methods: This study consecutively enrolled patients with TN who were scheduled for PBC of the Gasserian ganglion between February 2020 and February 2023. Some patients who underwent the procedure were placed on an extended operating table, whereas others were placed on a traditional operating table. The primary outcome was the duration of the cervical extension. The secondary outcomes included the duration of patient positioning, operation duration, C-arm radiation exposure, and pressure pain threshold of the bilateral trapezius, levator scapulae, and upper trapezius muscles, as well as the occurrence rate of postoperative complications., Results: A total of 76 patients (mean age of 53.18 ± 2.74 years old, 44 men) were enrolled, with 38 patients using the extended operating table. The baseline characteristics between the extended and traditional operating table groups were comparable (P > 0.05). The duration of the cervical extension was significantly shorter in patients who used an extended operating table than in those who used a traditional operating table (58.77 ± 2.11 vs. 76.49 ± 2.16, P < 0.001). Patients who used an extended operating table exhibited significantly shorter positioning time (3.40 ± 0.45 vs. 10.32 ± 0.66, P < 0.001), operation duration (50.88 ± 2.95 vs. 76.49 ± 2.16, P = 0.020), and C-arm radiation exposure (8.71 ± 1.06 vs. 10.87 ± 1.26, P < 0.001) and significantly higher postoperative 24-hour pressure pain thresholds of the bilateral trapezius muscle (left: 274.39 ± 10.42 vs. 187.05 ± 6.19, P < 0.001; right: 272.89 ± 11.62 vs. 185.42 ± 6.88, P < 0.001), bilateral levator scapulae (left: 357.71 ± 11.37 vs. 245.34 ± 12.87, P < 0.001; right: 353.71 ± 14.14 vs. 245.05 ± 13.20, P < 0.001), and bilateral upper trapezius (left: 253.63 ± 10.91 vs. 163.95 ± 8.44, P < 0.001; right: 255.66 ± 11.99 vs. 165.32 ± 7.93, P < 0.001) compared to those who used a traditional operating table. The occurrence of postoperative adverse events, such as headache, neck pain, back pain, and limb numbness, was significantly lower in the extended operating table group (2.63% vs. 13.79%, P = 0.047) than in the traditional operating table group., Limitations: This is a single-center study with a small, homogeneous sample, limiting the generalizability of findings; the absence of randomization raises concerns about potential bias; long-term follow-up and recurrence rate measurements were lacking., Conclusion: This study found that the extended operating table may be an alternative equipment option for C-arm-guided PBC of the Gasserian ganglion for TN.

Background: The classic percutaneous balloon compression (PBC) technique is used to complete an operation under the guidance of C-arm radiography under general anesthesia, making communication with patients during the operation impossible. It is not accurate or objective to predict the classic technique's curative effect solely by determining whether the projection of the x-ray lateral image of the filled balloon is pear-shaped., Objectives: This study aimed to upgrade classic PBC to awake computed tomography (CT)-guided PBC technology under conscious local anesthesia and analgesia monitoring., Study Design: Prospective clinical study., Setting: Department of Anesthesiology and Pain Medical Center, Jiaxing, People's Republic of China., Methods: Puncture was designed and guided by CT scanning, and the curative effect was assessed by asking the patients about what they are feeling during the operation., Results: CT can design the puncture path and accurately guide puncture, observe the position and shape of the balloon through 3-dimensional reconstruction during the operation, and judge the curative effect according to the patient's chief concern., Limitations: Local anesthetic analgesia is not perfect, resulting in some patients experiencing pain during surgery., Conclusions: PBC can be completed under conscious local anesthesia and analgesia. Its curative effect and operative end standard can be determined according to the patient's chief concern. Under CT guidance, the puncture path can be designed to complete an accurate puncture and to intuitively understand the position and shape of the balloon.

Background: Trigeminal neuralgia (TN) is the most common excruciating cranial neuralgia in the elderly population. Radiofrequency thermocoagulation (RFT) of the trigeminal ganglion is an alternative treatment for medically intractable patients with TN. RFT cannula tip position is an important issue since it is related to treatment outcome and patient safety., Objectives: The purpose of this study was to evaluate the fluoroscopic position of a cannula tip when a maximal stimulation-induced paresthesia was obtained and the treatment outcome using a Barrow Neurological Institute (BNI) pain scale., Study Design: Retrospective analysis., Setting: An interventional pain management practice in South Korea., Methods: The final cannula tip position obtained under maximal electrical stimulation of the face was analyzed using previously saved fluoroscopic images., Results: The cannula tip was located exactly in the clival line in 10 patients (29.4%) with maxillary division (V2) TN. There were 24 patients of V2 TN (70.5% ) in whom the cannula tip was located below the clival line. Over 50% of cannula tips were located at -11 mm to -15 mm below the clival line in mandibular division (V3) TN. Forty-four patients (83%) who received RFT in the trigeminal ganglion demonstrated BNI I or II., Limitations: The number of patients with V3 TN was smaller than that of V2 TN. Only short-term efficacy was evaluated, but not long-term efficacy or recurrence rate of facial pain., Conclusions: Nearly 70% of patients in V2 TN and all patients in V3 TN, the cannula tip was positioned below the clival line. RFT of the trigeminal ganglion showed a successful treatment outcome with BNI I or II in 83% of patients.

Background: Percutaneous radiofrequency ablation (RFA) of the trigeminal Gasserian ganglion via the foramen ovale is still one of the classic treatments for primary trigeminal neuralgia. However, the Gasserian ganglion is deep in the middle cranial fossa. Although it is a structure outside the brain tissue, the puncture needle must enter the encephalic to reach the Gasserian ganglion and so it is difficult to completely avoid the risk of intracranial hemorrhage and infection caused by puncture damage to intracranial blood vessels. It is not clear whether if it is possible for RFA at the extracranial non-gasserian-ganglion site via the exit of the cranial channel (foramen ovale) for patients with V3 trigeminal neuralgia (TN)., Study Design: Prospective, clinical research study., Setting: Department of Anesthesiology and Pain Medical Center, Jiaxing, China., Methods: One hundred and seven patients with isolated mandibular branch trigeminal neuralgia were included. Radiofrequency thermocoagulation was performed by CT-guided percutaneous puncture through the foramen ovale. The puncture target was the midpoint of the horizontal transverse diameter of the oval foramen. If the tingling sensation in the mandibular nerve innervation area could be detected, the radiofrequency thermocoagulation (90°C, 120 sec) under intravenous anesthesia would be performed. We investigated the inclination angle, puncture angle and depth, puncture operation time, intraoperative complications and short-term and long-term results after operation., Results: After radiofrequency thermocoagulation, the pain in the mandibular branch dominant area was completely diminished in 104 patients. Two patients were cured after the second radiofrequency treatment. No intracranial hemorrhage not infection complications occurred, except for facial hematoma during operation in 21 cases. After 12-24 months of follow-up, 9 patients had recurrence and were still effective after receiving additional extracranial radiofrequency treatment., Limitations: A control group should be established and more clinical data should be collected in future work., Conclusion: Extracranial non-Gasserian-ganglion RF can achieve satisfactory results and improve the safety of radiofrequency treatment for trigeminal neuralgia.

Background: Radiofrequency thermal rhizotomy demonstrates an excellent treatment outcome with a high success rate among patients of intractable trigeminal neuralgia. The triangular plexus which is an immediate retrogasserian portion of the trigeminal root is suggested as the best place of lesioning during radiofrequency thermal rhizotomy. However, the anatomy of the triangular plexus has been relatively unrecognized, while the anatomical study related to therapeutic procedure is scarce., Objective: The purpose of this study is to confirm with gross and microscopic finding of the trigeminal system whether, if an electrode tip is placed on the petroclival junction in lateral cranial view, it actually arrives at the triangular plexus or not. In relation to therapeutic procedure, we examined the triangular plexus with morphological and histological methods., Study Design: Human cadaveric study., Setting: An anatomical laboratory in South Korea., Methods: Percutaneous procedure of radiofrequency thermal rhizotomy under C-arm guidance was performed in 8 cadavers. Final target of the electrode tip was the petroclival junction under true lateral cranial view. The location of the electrode tip was determined under observation of the presence of an injected dye. Triangular plexus size was measured grossly and microscopically. Gross and microscopic evaluation of the triangular plexus was performed., Results: Among 15 trigeminal systems, 8 showed dye appearance in the triangular plexus, while 6 showed it in the trigeminal ganglion. Overall, 53% of radiofrequency thermal rhizotomy could reach the triangular plexus when an electrode tip was placed on the petroclival junction. The grossly measured average triangular plexus vertical and transverse diameters were 0.8 cm and 1.3 cm, respectively., Limitation: Only radiologic landmark was used to confirm the location of the electrode tip. However, further study confirming the location of the electrode tip under the guidance of electrical stimulation is needed., Conclusion: When an electrode tip was placed on the petroclival junction, 53% of radiofrequency thermal rhizotomy could reach the triangular plexus.

Background: Trigeminal neuralgia is a very painful condition, and radiofrequency therapy is reserved for patients who are resistant or intolerant to pharmacologic therapy. Continuous radiofrequency (CRF) and pulsed radiofrequency (PRF) both have advantages and disadvantages. Recently, studies have found that PRF combined with low-temperature (< 65°C) CRF increases the efficacy of treatment, without leading to a significant increase in complications caused by nerve lesions. However, these reports have some limitations., Objectives: We plan to conduct a randomized, controlled study to compare the efficacy of applying high-voltage PRF, with and without low-temperature CRF, to the Gasserian ganglion for the treatment of trigeminal neuralgia., Study Design: A study protocol for a prospective, open-label, parallel, randomized controlled trial (clinicaltrials.gov; NCT04174443)., Setting: The Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University in Beijing, China., Methods: One hundred forty-six patients with primary trigeminal neuralgia will be randomly assigned to 1 of 2 groups using an allocation ratio of 1:1. In the high-voltage PRF combined with low-temperature CRF group, 2 Hz of PRF will be applied under the following conditions: a voltage of 70 V, temperature of 42°C, pulse width of 20 ms, and treatment time of 600 s. Low-temperature CRF will then be performed at 60°C, with a treatment time of 270 s. In the high-voltage PRF group, only high-voltage PRF will be performed, using the same treatment parameters. Follow-up process will last for a duration of 1 year., Results: The primary outcome will be the effectiveness of the treatment after 12 months, which is the percentage of patients with a modified Barrow Neurological Institute Pain Intensity Score (BNI) between I and III. The secondary outcome will include the following: BNI score, Numeric Rating Scale, dose of carbamazepine or oxcarbazepine, patient satisfaction score, quality of life, numbness, side effects, and adverse reactions. These will be recorded over a 1-year follow-up period., Limitations: The open-label study design may influence the measurement of outcomes and introduce bias, for example, performance or ascertainment bias., Conclusions: To our knowledge, this will be the first prospective, open-label, parallel, randomized controlled trial to compare the efficacy and safety of the application of high-voltage PRF, combined with and without low-temperature (60°C) CRF, for the patients who have failed to respond to pharmacologic treatments for primary trigeminal neuralgia. If proven effective, this will be an important, safe, minimally destructive alternative treatment modality for primary trigeminal neuralgia following an ineffective conservative treatment.