Long-term Outcomes of Computerized Tomography-Guided Sphenopalatine Ganglion-Targeted Pulsed Radiofrequency for Refractory Cluster Headache.

OBJECTIVE: To further evaluate the efficacy and safety of computerized tomography-guided sphenopalatine ganglion-targeted pulsed radiofrequency treatment for patients with refractory episodic and chronic cluster headache (CH). METHODS: Forty-five patients with refractory episodic CH and 14 patients with chronic CH who underwent computerized tomography-guided sphenopalatine ganglion-targeted pulsed radiofrequency between January 2011 and December 2018 at the Beijing Tiantan Hospital were included and analyzed in this retrospective cohort study. RESULTS: A total of 59 patients underwent 106 computerized tomography-guided pulsed radiofrequency procedures throughout the observational period. Effective remission was observed in 95.6% and 64.3% of patients with refractory episodic and chronic CH, respectively. Repeated computerized tomography-guided sphenopalatine ganglion-targeted pulsed radiofrequency procedures for recurrent CH was also proven to be effective. No severe side effects or complications were observed in this study. CONCLUSION: The computerized tomography-guided sphenopalatine ganglion-targeted pulsed radiofrequency procedure is an effective, safe, and repeatedly effective strategy for refractory CH. For patients who have not responded to conservative treatment, this minimally invasive intervention is a reliable alternative.

Optogenetic probing and manipulation of the calyx-type presynaptic terminal in the embryonic chick ciliary ganglion.

The calyx-type synapse of chick ciliary ganglion (CG) has been intensively studied for decades as a model system for the synaptic development, morphology and physiology. Despite recent advances in optogenetics probing and/or manipulation of the elementary steps of the transmitter release such as membrane depolarization and Ca(2+) elevation, the current gene-manipulating methods are not suitable for targeting specifically the calyx-type presynaptic terminals. Here, we evaluated a method for manipulating the molecular and functional organization of the presynaptic terminals of this model synapse. We transfected progenitors of the Edinger-Westphal (EW) nucleus neurons with an EGFP expression vector by in ovo electroporation at embryonic day 2 (E2) and examined the CG at E8-14. We found that dozens of the calyx-type presynaptic terminals and axons were selectively labeled with EGFP fluorescence. When a Brainbow construct containing the membrane-tethered fluorescent proteins m-CFP, m-YFP and m-RFP, was introduced together with a Cre expression construct, the color coding of each presynaptic axon facilitated discrimination among inter-tangled projections, particularly during the developmental re-organization period of synaptic connections. With the simultaneous expression of one of the chimeric variants of channelrhodopsins, channelrhodopsin-fast receiver (ChRFR), and R-GECO1, a red-shifted fluorescent Ca(2+)-sensor, the Ca(2+) elevation was optically measured under direct photostimulation of the presynaptic terminal. Although this optically evoked Ca(2+) elevation was mostly dependent on the action potential, a significant component remained even in the absence of extracellular Ca(2+). It is suggested that the photo-activation of ChRFR facilitated the release of Ca(2+) from intracellular Ca(2+) stores directly or indirectly. The above system, by facilitating the molecular study of the calyx-type presynaptic terminal, would provide an experimental platform for unveiling the molecular mechanisms underlying the morphology, physiology and development of synapses.

Quantitative sensory testing may predict response to sphenopalatine ganglion pulsed radiofrequency treatment in cluster headaches: a case series.

Pulsed radiofrequency treatment has been described as a nonablative alternative to radiofrequency thermocoagulation for the management of certain chronic pain syndromes. We present our first three patients with long-standing cluster headaches who were treated with pulsed radiofrequency to the sphenopalatine ganglion. All three patients have had cluster headaches for more than 10 years' duration and experienced minimal relief with conservative treatment. An excellent midterm effect was achieved in two of the three patients and a partial effect in one. No neurological side effects or complications were reported. Quantitative sensory testing consisting of allodynia testing, pressure-pain thresholds, electrical pain thresholds, and conditioned pain modulation (CPM) response testing were used to monitor their sensory processing changes before and after the procedure. From this case series, it might be that cluster headache patients with an impaired CPM response with or without signs of allodynia will respond less favorably to interventional treatment. Further studies are required to validate this hypothesis.

[Treatment of trigeminal neuralgia, ganglioneuritis of the pterygopalatine ganglion and other types of prosopalgias by helium-neon laser irradiation of the pterygopalatine ganglion]. / Lechenie nevralgii troinichnogo nerva, ganglionevrita krylonebnoogo uzla i drugikh vidov prozopalgii oblucheniem krylonebnogo uzla gelii-neonovym lazerom.

The authors describe a method of contact helium-neon laser irradiation of the pterygopalatine node through lateral wall of the nasal cavity. The technique was employed in patients with trigeminal neuralgia, ganglioneuritis of pterygopalatine node, other forms of prosopalgia. Altogether 78 patients were treated. The initial course relieved pain in 56 patients. In 44 patients the remission has been persisting for 2 years.