Computed Tomography-Guided Percutaneous Stylomastoid Foramen Puncture and Radiofrequency Thermocoagulation for Treatment of Hemifacial Spasm via Mandibular Angle Approach.

BACKGROUND: Hemifacial spasm (HFS) is characterized by progressive, paroxysmal, and involuntary convulsions on one side of the face. We have conducted in-depth exploration on the puncture approach through the mandibular angle, which is an important supplement to the first 2 approaches (i.e., premastoid approach and the postmastoid approach), especially for patients who cannot find a suitable way before and after the mastoid process. OBJECTIVES: To investigate the effect of computed tomography (CT)-guided percutaneous mandibular angle radiofrequency thermocoagulation (RFT) of facial nerve through the stylomastoid foramen in treating HFS. STUDY DESIGN: A retrospective, observational study. SETTING: Pain Department, Jiaxing and Hangzhou, China. METHODS: A total of 89 patients with HFS who underwent CT-guided RFT in the Pain Department of Zhejiang Integrated Traditional Chinese and Western Medicine Hospital and the Pain Department of Jiaxing First Hospital, from June 2020 to June 2022, were retrospectively analyzed, including 29 men and 60 women, aged 34~88 (59.8 ± 11.1). They were divided into 3 groups: anterior mastoid approach group (Group A, n = 38), posterior mastoid approach group (Group P, n = 26), and mandibular angle approach group (Group M, n = 25), according to the different puncture approaches. Puncture time, minimum stimulating current triggering facial muscle twitches, temperature at the end of RFT and duration time of RFT at this temperature, and total treatment time, as well as degree of facial paralysis and complications one-day postoperation, were compared among the 3 groups. RESULTS: The puncture times (mean ± SD) of Group A, Group P, and Group M were (30.63 ± 4.88), (31.35 ± 5.89), and (35.08 ± 5.76), respectively, and the differences were statistically significant (P = 0.006). The puncture time of Group M was longer than that of Groups A and P (P < 0.05). The minimum stimulating current triggering facial muscle twitches in the 3 groups were (0.49 ± 0.16), (0.43 ± 0.14), and (0.28 ± 0.09), respectively, with a statistically significant difference (P = 0.000). The minimum stimulation current in Group M was less than that in Groups A and P (P < 0.05). The temperature at the end of RFT of the 3 groups was (78.29 ± 7.91), (76.54 ± 8.10), and (66.60 ± 8.00), respectively, and the differences were statistically significant (P < 0.001). The temperature of Group M was lower than Groups A and P (P < 0.05). There were no significant differences among the 3 groups in the total operation time or the degree of facial paralysis one-day postoperation (P > 0.05). No hematoma, infection, hearing impairment, or other complications were reported in any patients. LIMITATIONS: The nonrandomized nature, small sample size, and retrospective design are limitations of this study. CONCLUSIONS: CT-guided RFT through the stylomastoid foramen is an effective treatment of HFS. Compared to the poster and anterior mastoid approaches, the mandibular angle approach was found to be more effective in terms of reduced minimum stimulating current and reduced-end RFT temperature, which means fewer potential complications to the patient postsurgery. KEY WORDS: Hemifacial spasm, radiofrequency thermocoagulation, stylomastoid foramen, CT-guided.

Comparison of Two Puncture Approaches in CT-guided Percutaneous Radiofrequency Ablation at the Stylomastoid Foramen for Treatment of Hemifacial Spasm.

BACKGROUND: Hemifacial spasm (HFS) is mainly characterized by paroxysmal involuntary twitches of one side of the facial muscles. We developed an awake CT-guided percutaneous puncture of the stylomastoid foramen for radiofrequency ablation (RFA) therapy for the treatment of hemifacial spasm and successfully used it in our clinic. OBJECTIVE: We aimed to compare anterior or posterior mastoid approaches in CT-guided percutaneous RFA at the stylomastoid foramen for the treatment of HFS. STUDY DESIGN: Prospective, clinical research study. SETTING: Department of Anesthesiology and Pain Medical Center, Ningbo, China. METHODS: Sixty-eight patients with HFS were recruited. They were divided into 2 groups: anterior mastoid approach and posterior mastoid approach. With the patient were under minimal sedation, a radiofrequency  needle was used to reach the stylo-mastoid foramen on the affected side by an anterior approach or posterior approach; the facial nerve was localized using a low-frequency stimulation current. Ablation stopped when the patient's hemifacial contracture resolved. The puncture depth, angle, intraoperative and postoperative complications, and the short-term and long-term efficacy of the 2 puncture approaches were recorded. RESULTS: The HFS disappeared completely in 37 and 24 cases of the anterior and posterior group, but cases of both groups exhibited a House-Brackmann Facial Paralysis Scale Grade II or Grade III. During one-24 months of follow-up, 5 cases and 3 cases recurred respectively in the two groups. After 6 months of follow-up, the facial paralysis symptoms of patients in both groups disappeared. CONCLUSION: There was no difference in the operation time or efficacy between the 2 approaches. The anterior mastoid approach is easier to perform and is recommended based on our experience.

CT-guided radiofrequency ablation of the extracranial cranial nerve for the treatment of Meige's syndrome.

Background: Meige' s syndrome, a rare form of dystonia, lacks effective treatment. The purpose of this study was to determine the effects of CT-guided percutaneous extracranial radiofrequency ablation of the facial and/or trigeminal nerves in the treatment of Meige's syndrome. Methods: A total of 10 patients were enrolled in this study, with the numbers of blepharospasm dystonia syndrome (BDS), oromandibular dystonia syndrome (ODS), and blepharospasm combined with oromandibular dystonia syndrome (B-ODS) being 7, 1, and 2, respectively. BDS patients underwent radiofrequency ablation of the bilateral stylomastoid foramen facial nerve; ODS patients underwent radiofrequency ablation of the bilateral foramen oval trigeminal mandibular branch, and B-ODS patients underwent radiofrequency ablation of the bilateral stylomastoid foramen facial nerve and foramen oval trigeminal mandibular branch. The therapeutic effects and complications were observed. Results: All 10 patients in this series experienced improved Meige's syndrome-related symptoms after extracranial radiofrequency ablation of the cranial and/or mandibular branches of the extracranial trigeminal nerve. Adverse events included class II-III facial paralysis and/or mandibular skin numbness. Two patients had recurrences at the 18th and 22nd months postoperatively, respectively; the other patients were being followed up. Conclusion: These results shown that CT-guided radiofrequency ablation of bilateral stylomastoid foramen facial nerve and/or oval foramen trigeminal mandibular branch can effectively treat the corresponding types of Meige's syndrome. According to preliminary observations, the therapeutic effect may last more than 18 months.

Clinical Observation of CT-Guided Intervertebral Foramen Puncture and Radiofrequency Thermocoagulation for the Treatment of Refractory PHN in the Superior Thoracic Segment.

BACKGROUND: Post-herpetic neuralgia (PHN) is a typical neuropathic pain. Conventional oral analgesics and nerve block therapy can only obtain temporary analgesia in many cases. This study summarized the clinical effect of CT-Guided intervertebral foramen puncture and radiofrequency thermocoagulation through the superior margin of costotransverse joint for the treatment of refractory PHN in the superior thoracic segment. OBJECTIVES: To observe the efficacy of CT-Guided intervertebral foramen puncture and radiofrequency thermocoagulation (RFT) treatment of refractory PHN in the T1 ~ T3 spinal innervation area. STUDY DESIGN: A retrospective, observational study. SETTING: Pain department, Jiaxing and Hangzhou, China. METHODS: Thirty-six patients with intractable superior thoracic PHN were admitted to the Pain Department. After the positioning image of CT was taken by prone, the upper thoracic segment was scanned in axial position with the layer thickness of 3 mm of spinal model.The puncture path was designed by selecting the slice of the foramen and costotransverse joint from the obtained images. The needle was inserted to the corresponding foramen. After confirmation by high and low frequency current stimulation tests, the RFT was performed at 90°C for 180s. A numeric rating scale (NRS) for pain was recorded before surgery, 2 hours, 1 week, 4 weeks and 8 weeks after surgery and the mental state was assessed with the SF-36 clinical questionnaire before surgery, 4 weeks and 8 weeks after surgery. RESULTS: Following RFT intervention the measured pain NRS significantly decreased after 2 hours, 1 week, 4 weeks and 8 weeks (P < 0.01). SF-36 scores in all categories increased 4 and 8 weeks after the operation (P < 0.01). No serious adverse effects were reported during the study period and no hypoxemia was found under intraoperative nasal catheter oxygen inhalation. LIMITATIONS: Limitations of this study include the small sample size, and nonrandomized retrospective design. CONCLUSION: CT-Guided intervertebral foramen puncture and RFT through the superior margin of the costotransverse joint can effectively improve refractory PHN in the superior thoracic segment with good safety.

Extracranial Radiofrequency Treatment for Painful Tic Convulsif Syndrome Under Local Anesthesia.

INTRODUCTION: Painful tic convulsif syndrome is ipsilateral facial trigeminal neuralgia combined with hemifacial spasm, which is relatively rare in the clinic. Microvascular decompression is currently considered to be an effective treatment. We report extracranial radiofrequency treatment of painful tic convulsif syndrome under local anesthesia, a technique which provides a safer and more economical treatment for this kind of patient. CASE PRESENTATION: We report a case of painful tic convulsif syndrome which was treated with extracranial radiofrequency therapy of the trigeminal nerve and facial nerve. After operations, the symptoms of pain and spasm were relieved immediately, but the right facial numbness and facial paralysis (House-Brackmann grade III) were left. The facial paralysis was completely relieved after 3 months of follow-up, and there was no recurrence of trigeminal neuralgia or hemifacial spasm after 35 months. DISCUSSION: Painful tic convulsif syndrome is a combination of ipsilateral facial trigeminal neuralgia and hemifacial spasm, which is relatively rare in the clinic. So far, only one treatment method of microvascular decompression has been reported for the disease. We report the first case of CT-guided extracranial radiofrequency therapy for painful tic convulsif syndrome. CONCLUSION: Extracranial radiofrequency therapy can provide safe and economical treatment for patients with painful tic convulsif syndrome.

Use of transcutaneous electrical acupoint stimulation in pulmonary surgery for patients with tuberculosis.

Objective: This study aimed to analyze the effects of transcutaneous electrical acupoint stimulation (TEAS) on the immune function in patients with pulmonary tuberculosis (PT) and the inflammatory response following one-lung ventilation surgery by comparing the levels of inflammatory mediators, such as tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), and interleukin 8 (IL-8); T lymphocyte subsets, including CD3+, CD4+, CD8+, and CD4+/CD8+ cells; and natural killer cells (NK cells). Methods: We randomly divided 62 patients who underwent general anesthesia for thoracotomy into two groups: TEAS and sham TEAS. Patients in the TEAS group underwent bilateral acupoint electrical stimulation at the Hou-Xi, Zhi-Gou, Nei-Guan, and He-Gu acupoints from 30 min before anesthesia induction until the end of surgery. TEAS was continuously maintained throughout the procedure with a dilatational wave at 2/100 Hz. Those in the sham TEAS group underwent the same management but without stimulation, and the anesthesia induction and maintenance methods were the same in both groups. Venous blood was drawn to monitor inflammatory mediators and lymphocyte subsets before anesthesia induction and 5 days after the surgery. Results: There was no statistical difference in the general conditions between the two groups (P > 0.05). Before anesthesia induction, the levels of inflammatory factors (IL-6, IL-8, and TNF-α), lymphocyte subsets (CD3+, CD4+, and CD4+/CD8+), and NK cells did not statistically differ between the two groups (P > 0.05). Compared to the sham TEAS group, the levels of IL-6, IL-8, TNF-α, and CD8+ were lower in the TEAS group, while those of CD3+, CD4+, CD4+/CD8+, and NK cells were higher; however, only the change in TNF-α was significant (P < 0.05). Conclusion: TEAS at the Hou-Xi, Zhi-Gou, Nei-Guan, and He-Gu acupoints at 2 Hz/100 Hz can reduce the inflammatory response during one-lung ventilation but has no significant effect on the immune function in patients with tuberculosis.

Efficacy and Safety of Awake Computed Tomography-Guided Percutaneous Balloon Compression of Trigeminal Ganglion for Trigeminal Neuralgia.

OBJECTIVES: To describe the method and clinical efficacy of awake computed tomography (CT)-guided percutaneous balloon compression (PBC) as a treatment for trigeminal neuralgia (TN). DESIGN: In this case series, patients with TN were treated with awake CT-guided PBC and followed up for treatment efficacy and complications for 12 months. SETTING: A single-center study. SUBJECTS: A total of 66 patients with medical treatment-refractory TN were recruited for the study. METHODS: The procedure was performed under moderate sedation. A balloon catheter was inserted through a trocar needle to reach Meckel's cavity under CT guidance. The position and optimal shape of the contrast-filled balloon were confirmed with CT three-dimensional reconstruction. Compression of the trigeminal ganglion was considered complete when the patient notified operators about facial hypoesthesia or the resolution of TN symptoms. All patients were followed up monthly for 12 months to monitor treatment efficacy and complications. RESULTS: The average trigeminal ganglion compression time was 272 ± 81 seconds, at which point the patients reported significant facial hypoesthesia compared with the contralateral side or resolution of triggered pain in the affected area. All patients had resolution of TN symptoms for 6 months, with a 1-year recurrence rate of 13%. The overall safety profile was improved with the technique described in this study. Side effects, such as hypoesthesia and mastication weakness, were overall mild and did not impact patients' quality of life. Some complications that historically have been associated with PBC, such as diplopia and keratitis, were not present. CONCLUSIONS: This new awake CT-guided PBC technique produces better outcomes than the traditional PBC under fluoroscopy guidance and general anesthesia.

Awake CT-guided percutaneous stylomastoid foramen puncture and radiofrequency ablation of facial nerve for treatment of hemifacial spasm.

OBJECTIVE: Hemifacial spasm (HFS) is a debilitating neuromuscular disorder with limited treatment options. The current study describes a novel minimally invasive procedure that provided effective and sustained relief for patients with HFS. The authors provide a detailed description of the awake CT-guided percutaneous radiofrequency ablation (RFA) of the facial nerve for treatment of HFS, and they examine its clinical efficacy. This is the first time in the literature that this procedure has been applied and systematically analyzed for HFS. METHODS: Patients with a history of HFS were recruited between August 2018 and April 2020. Those with a history of cerebellopontine lesions, coagulopathy, ongoing pregnancy, cardiac pacemaker or defibrillator implants, or who declined the procedure were excluded from the study. Fifty-three patients who met the study criteria were included and underwent awake CT-guided RFA. Under minimal sedation, a radiofrequency (RF) needle was used to reach the stylomastoid foramen on the affected side under CT guidance, and the facial nerve was localized using a low-frequency stimulation current. Patients were instructed to engage facial muscles as a proxy for motor monitoring during RFA. Ablation stopped when the patients' hemifacial contracture resolved. Patients were kept for inpatient monitoring for 24 hours postoperatively and were followed up monthly to monitor resolution of HFS and complications for up to 19 months. RESULTS: The average duration of the procedure was 32-34 minutes. Postoperatively, 91% of the patients (48/53) had complete resolution of HFS, whereas the remaining individuals had partial resolution. A total of 48 patients reported mild to moderate facial paralysis immediately post-RFA, but most resolved within 1 month. No other significant complication was observed during the study period. By the end of the study period, 5 patients had recurrence of mild HFS symptoms, whereas only 2 patients reported dissatisfaction with the treatment results. CONCLUSIONS: The authors report for the first time that awake CT-guided RFA of the facial nerve at the stylomastoid foramen is a minimally invasive procedure and can be an effective treatment option for HFS.