Ultrasound Guided Infraorbital Nerve Radiofrequency Thermocoagulation in Patients with Trigeminal Neuralgia

AbstractBackgroundTrigeminal neuralgia is a neuropathic disorder characterized by episodes of intense pain in the face. Drug therapy is the first choice of treatment. However, in cases where drug therapy are contraindicated due to side effects, patients can get pain relief from lengthy neurosurgical procedures. Alternatively, a peripheral trigeminal nerve block can be easily performed in an outpatient setting. Therefore it is a useful treatment option for the acute paroxysmal period of TN in patients who cannot use drug therapy. We performed real-time ultrasound guidance for infraorbital nerve blocks in TN patients using a high concentration of tetracaine dissolved in bupivacaine. In this report, we examine the efficacy of our methods.PatientsAs approved by the Institutional Review Board, the medical records in our hospital were queried retrospectively. Six patients with TN at the V2 area matched the study criteria. All patients could not continue drug therapy with carbamazepine due to side effects and they received an ultrasound-guided infraorbital nerve block with a high concentration of tetracaine dissolved in bupivacaine.MethodsThe patient was placed in the supine position and the patient’s face was sterilized and draped. An ultrasound system with a 6-13 MHz linear probe was used with a sterile cover. The probe was inserted into the horizontal plane of the cheek just beside the nose and was slid in the cranial direction to find the dimple of the infraorbital foramen. The 25G 25 mm needle was inserted from the caudal side just across from the probe using an out-of-plane approach. To lead the needle tip to the foramen, needle direction was corrected with real-time ultrasound guidance. After the test block with lidocaine (2%, 0.5 ml), a solution of tetracaine (20 mg) dissolved in bupivacaine (0.5%, 0.5 ml) was injected. During each injection, the spread of the agent around the nerve was confirmed using ultrasound images.ResultsTen blocks were performed for six patients. Immediately after the procedure, all 10 blocks produced analgesia and relieved the pain. In the three blocks, pain was experienced in a new trigger point outside of the infraorbital nerve region (around the back teeth) within a week after the block and pain were relieved using other treatment. Two patients developed small hematomas in the cheek but they disappeared in a week. All patients did not complain about other side effects including paraesthesia, hyperpathia, dysaesthesia, or double vision. Hypoaesthesia to touch and pain in the infraorbital region were observed in all blocks after 2 weeks.ConclusionsWe performed real-time ultrasound-guided infraorbital nerve block for TN with a high concentration of tetracaine dissolved in bupivacaine. Our method achieved a high success rate and there were only minor and transient side effects.ImplicationsReal-time ultrasound-guided infraorbital nerve block is one of the useful options to treat the acute paroxysmal period of TN at the infraorbital nerve area. Ultrasound-guided injections may become the standard practice for injecting peripheral trigeminal nerves. Using this high concentration of tetracaine as a neurolytic agent is effective and appears to have only minor side effects.

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The Long-Term Effective Rate of Different Branches of Idiopathic Trigeminal Neuralgia After Single Radiofrequency Thermocoagulation

Medicine ◽

10.1097/md.0000000000001994 ◽

2015 ◽

Vol 94 (45) ◽

pp. e1994 ◽

Cited By ~ 17

Author(s):

Yuan-Zhang Tang ◽

Bai-Shan Wu ◽

Li-Qiang Yang ◽

Jian-Ning Yue ◽

Liang-Liang He ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Effective Rate ◽

Radiofrequency Thermocoagulation ◽

Idiopathic Trigeminal Neuralgia

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Comparison of the Efficacy of Reoperation, Percutaneous Radiofrequency Thermocoagulation When Microvascular Decompression of Trigeminal Neuralgia Is Invalid

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000002971 ◽

2016 ◽

Vol 27 (7) ◽

pp. e688-e690 ◽

Cited By ~ 7

Author(s):

Xin Zhang ◽

Hua Zhao ◽

Yinda Tang ◽

Jin Zhu ◽

Xuhui Wang ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Radiofrequency Thermocoagulation

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Comparison of nerve combing and percutaneous radiofrequency thermocoagulation in the treatment for idiopathic trigeminal neuralgia

Brazilian Journal of Otorhinolaryngology ◽

10.1016/j.bjorl.2015.11.006 ◽

2016 ◽

Vol 82 (5) ◽

pp. 574-579 ◽

Cited By ~ 12

Author(s):

Xuanchen Zhou ◽

Yiqing Liu ◽

Zhiyong Yue ◽

Deheng Luan ◽

Hong Zhang ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Radiofrequency Thermocoagulation ◽

Idiopathic Trigeminal Neuralgia

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Down-regulation of MAPK pathway alleviates TRPV4-mediated trigeminal neuralgia by inhibiting the activation of histone acetylation

Experimental Brain Research ◽

10.1007/s00221-021-06194-6 ◽

2021 ◽

Author(s):

Weidong Liu ◽

Benfang Pu ◽

Mindi Liu ◽

Xuejun Zhang ◽

Ran Zeng

Keyword(s):

Trigeminal Neuralgia ◽

Western Blot ◽

Histone Acetylation ◽

Transient Receptor Potential ◽

Mapk Pathway ◽

Quantitative Polymerase Chain Reaction ◽

Infraorbital Nerve ◽

Enzyme Linked Immunosorbent Assay ◽

Transient Receptor Potential Vanilloid ◽

Down Regulation

AbstractOur objective of this study is to determine the molecular mechanism of MAPKs (mitogen activated protein kinase systems) on TRPV4 (transient receptor potential vanilloid 4)-mediated trigeminal neuralgia (TN). Partial chronic constriction injury of the infraorbital nerve (CCI-ION) ligation model was used in this research. When treated with antagonists of p38, JNK or ERK, the mechanical hyperalgesia threshold, nerve fiber disorder, myelinoclasis, and Schwann cells proliferation could be reversed. RT-PCR (real-time quantitative polymerase chain reaction), Western blot and IHC (immunohistochemistry) showed that TRPV4 mRNA and protein levels, TRPV4-positive cells and small positive neurons decreased remarkably in TN group treated with antagonists of p38, JNK or ERK. ELISA (enzyme-linked immunosorbent assay) was performed to discover inhibition of MAPK pathway can down-regulate the expression of HATs (histone acetyltransferases), and up-regulate the expression of HDACs (histone deacetylases) in TN, thus inhibiting histone acetylation. Finally, Western blot was performed to identify the phosphorylation status of p38, JNK and ERK, finding decreased phosphorylation forms in antagonists treated TN groups compared with TN groups. Based on the above investigation method, on a whole, our study showed that down-regulation of MAPK pathway could alleviate TRPV4-mediated trigeminal neuralgia, via inhibiting the activation of histone acetylation.

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