Background: Percutaneous trans-foramen ovale (FO) radiofrequency ablation (RFA) of Gasserian ganglion (GG) is commonly used to treat V3 trigeminal neuralgia (TN). However, this intracranial approach is less selective and safe. Objectives: To report a novel percutaneous within-FO RFA of the V3 under CT-guidance and outcomes with both bipolar and monopolar techniques. Patients and methods: Twenty-six patients with isolated V3 primary TN and FO >6 mm in diameter underwent either monopolar (n=12) or bipolar RFAs (n=14) based on their preference. Successful analgesia over V3, residual pain, recurrent pain, and complications were compared between the two groups. The ex vivo egg albumen model was used to demonstrate the size difference in the thermocoagulation lesion created by monopolar vs bipolar electrodes. Results: In the bipolar group, there were more cases of masticatory atonia as compared to the monopolar ( P =0.104), but no residual pain was observed. In the monopolar group, there were two cases of residual pain found, which led to immediate repeat RFAs. Therefore, during the immediate post-operative period, both groups obtained 100% complete V3 analgesia with a similar risk of facial hematoma ( P =0.641). During up to 27-months of post-operative follow-up, in the bipolar group, complete pain relief persisted in all patients; in the monopolar group, 1 case of recurrent pain was found at 14 months. Ex vivo study demonstrated that, at 90 °C/90 seconds of RFA, the width of lesions is significantly larger by the 6-mm spacing parallel-tip bipolar electrodes compared to the monopolar electrode (9.5±0.567 vs 5.5±0.07 mm). Conclusion: In treating patients with isolated V3 TN and FO >6mm in diameter, this percutaneously within-FO RFA of the V3 under CT guidance is both clinically practical and effective, while bipolar RFA is associated with a lower incidence of residual and recurrent pain likely due to larger lesion sizes.

Bone cancer pain (BCP) is an intractable clinical problem, and lacked effective drugs for treating it. Recent research showed that several chemokines in the spinal cord are involved in the pathogenesis of BCP. In this study, the antinociceptive effects of liquiritin, which is an active component extracted from Glycyrrhizae Radix, were tested and the underlying mechanisms targeting spinal dorsal horn (SDH) were investigated. The BCP group displayed a significant decrease in the mechanical withdrawal threshold on days 6, 12, and 18 when compared with sham groups. Intrathecal administration of different doses of liquiritin alleviated mechanical allodynia in BCP rats. The results of immunofluorescent staining and western blotting showed that liquiritin inhibited BCPinduced activation of astrocytes in the spinal cord. Moreover, intrathecal administration of liquiritin effectively inhibited the activation of CXCL1/CXCR2 signaling pathway and production of IL-1b and IL-17 in BCP rats. In astroglial-enriched cultures, Lipopolysaccharides (LPS) elicited the release of chemokine CXCL1, and the release was decreased in a dose-dependent manner by liquiritin. In primary neurons, liquiritin indirectly reduced the increase of CXCR2 by astroglial-enriched-conditioned medium but not directly on the CXCR2 target site. These results suggested that liquiritin effectively attenuated BCP in rats by inhibiting the activation of spinal astrocytic CXCL1 and neuronal CXCR2 pathway. These findings provided evidence regarding the the antinociceptive effect of liquiritin on BCP.

Objectives To describe the method and clinical efficacy of awake CT-guided percutaneous balloon compression (PBC) as a treatment for trigeminal neuralgia (TN). Design In this case-series, TN patients were treated with awake CT-guided PBC and followed for treatment efficacy and complications for 12 months. Setting A single-center study Subjects 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 was confirmed with CT 3-dimension reconstruction. Compression of the TG was considered completed 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 TG compression time was 272±81 seconds, at which point the patients reported significant facial hypoesthesia comparing to 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 recurrent rate of 13%. Overall safety profile is improved with the current technique. Side effects, such as hypoesthesia, and mastication weakness, were overall mild, and did not impact patients’ quality-of-life. Some complications that were historically 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.

Background. Primary V1 trigeminal neuralgia is a common refractory neuralgia in clinical practice, lacking effective treatments. Radiofrequency therapy has certain treatment efficacy, but its long-term efficacy remained poor and the disease might relapse. Objective. To compare the effects of different types of supraorbital foramen variations on the treatment efficacy of radiofrequency therapy for V1 trigeminal neuralgia. Methods. Data of 54 patients with V1 trigeminal neuralgia who underwent treatment in the First Hospital of Jiaxing, Zhejiang, were retrospectively analyzed. All these patients received CT-guided radiofrequency thermocoagulation of supraorbital nerve. According to the CT images, the supraorbital foramen of the patients was categorized as holes (hole group) or notches (notch group). The patient characteristics, including Numerical Rating Scale (NRS) score and effective treatment rates before and 1 d, 0.5 y, 1 y, and 2 y after operation, and numbness degree at day 1 and 2 y after the operation were compared. The short- and long-term complications during postoperative follow-up period were also recorded. Results. Among the 54 patients, 25 patients were grouped into the hole group and 29 into the notch group. The NRS scores before and at 1 d, 0.5 y, 1 y, and 2 y after operation showed no significant differences between the two groups. However, the NRS scores at the remaining time points after operation were significantly decreased when compared with scores before operation (P<0.05). The numbness and numbness degree after operation showed no significant differences between the two groups. The numbness degree at 2 y after operation was significantly lower than 1 d after operation (P<0.05). The effective rate at 1 d, 0.5 y, and 1 y after operation showed no significant differences between the hole and notch groups. However, the effective rate at 2 y after operation was significantly lower in the notch group than hole group (P<0.05). No severe short- or long-term complications were found in either group. Conclusion. The short- and long-term effective rates of radiofrequency therapy during V1 trigeminal neuralgia treatment are relatively high in patients with different types of supraorbital foramen variations. However, the effective rate is even higher in patients with hole-type supraorbital foramen. No other severe complications, except numbness, were found, and the acceptability rate remained high in patients.