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. KEY WORDS: Trigeminal neuralgia, foramen ovale, trigeminal ganglion
Bipolar disorder is a chronic mental disease with a heavy social and economic burden that causes extreme mood swings in patients. Valproate is a first-line drug for bipolar disorder patients to stabilize their daily mood. However, an excessive amount of valproate in the blood could induce severe adverse effects, which necessitates the monitoring of blood valproate levels for patients. Here, we developed an innovative electrochemical sensor for selective and simple detection of valproate based on a molecularly imprinted polymer membrane via one-step electropolymerization. Gold nanoparticles were electrochemically modified to the screen-printed electrode under the selective membrane to enhance its conductivity and stability. The successfully fabricated biosensor was characterized by scanning electron microscopy, cyclic voltammetry, and differential pulse voltammetry methods. The binding of the target molecules to the valproate-customized biomimetic polypyrrole membrane blocks cavities in the membrane and alters its electric properties, which can be detected as a decrease in the peak current by differential pulse voltammetry method. The peak current change presents a great log-linear response to the valproate concentration around the therapeutic window. The limit of detection of this method was 17.48 μM (LOD, S/N = 3) and the sensitivity was 31.86 μM μA−1. Furthermore, the biosensors exhibited both satisfying specificity with the interference of other psychological pharmaceutical drugs and uniformity among sensors, indicating their potential and reliability in translational application. This simple and reliable method of sensing valproate molecules primarily provides an exceptional solution to valproate point-of-care testing in clinical practice.
Background Postherpetic neuralgia (PHN) is a common complication of herpes zoster virus infection that is associated with intense pain. The present study aimed to investigate the use of computed tomography (CT)-guided radiofrequency ablation (RFA) of the cervical dorsal root ganglia (DRG) for treatment of cervical and occipital PHN in 27 patients at a single center. Material/Methods Twenty-seven patients with PHN in the cervical and/or occipital region were enrolled. After imaging the area of PHN in the patients, axial scanning was performed on the upper cervical segment in the spinal scanning mode. The puncture path was defined and then RFA therapy (90°C for 180 s) was performed by targeting the corresponding intervertebral foramen. Patients were followed 2 days later and at 1, 3, 6, and 12 months after surgery. Observation at each follow-up visit included rating of pain on a visual analog scale (VAS) and assessment of complications and adverse events. Results VAS scores significantly decreased in patients with PHN after RFA compared with their scores before RFA ( P <0.05). Skin sensation decreased in the area that was originally painful and allodynia significantly diminished. Conclusions The findings from this small study from a single center showed that CT-guided percutaneous RFA of cervical DRG safely and effectively reduced cervical and occipital PHN in the short term.
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