INTRODUCTION:Trigeminal neuralgia (TN), characterized by severe facial pain triggered by mild stimuli, is challenging to treat effectively and non-invasively. Traditional treatments, including microvascular decompression and medications like carbamazepine, have limitations. This study investigates the potential of Bulleyaconitine A (BAA), an alkaloid that selectively inhibits specific sodium channels, for managing TN in a rat model via intranasal administration. METHOD:Adult male Sprague-Dawley rats were subjected to a Chronic Constriction Injury (CCI) of the distal infraorbital nerve to model trigeminal neuralgia (TN). BAA was administered intranasally, and pain thresholds were assessed using the von Frey filament stimulation technique. Comparative analyses involved transnasal carbamazepine administration, with a focus on optimizing BAA dosage and delivery methods, including nasal drops, gavage, and subcutaneous injection. RESULT:Intranasal BAA significantly increased pain thresholds in TN rats, demonstrating superior performance compared to the control group and achieving efficacy comparable to carbamazepine over a two-week period. Among various administration routes evaluated, nasal delivery was identified as the most effective. DISCUSSION:The study shows BAA's superior efficacy compared to carbamazepine, highlighting its potential as a TTX-selective sodium channel blocker for TN. Intranasal BAA administration offers a novel, non-invasive therapeutic option. Further research on dosage forms for clinical use, such as drug-encapsulating nanoparticles or vesicles for targeted delivery in neurological disorders, is warranted.

Demyelination is widely acknowledged as the underlying pathological mechanism of trigeminal neuralgia (TN), while ferroptosis has been implicated in neurodegenerative disorders associated with demyelination. However, the precise contribution of ferroptosis to TN-related demyelination has yet to be elucidated. To investigate the putative pathway implicated in neuropathic pain, we conducted RNA-seq analysis in the IoN-CCI rat model that is deemed to simulate the pathology of TN. Subsequently, we explored iron metabolism and the ferroptosis-related pathway in this TN model. Finally, we utilized Ferrostatin-1 and Liproxstatin-1 to suppress ferroptosis and assessed alterations in iron metabolism and myelin sheath integrity through immunohistochemistry and transmission electron microscopy. Our experiments showed that IoN-CCI induced ferroptosis, characterized by increased iron accumulation and decreased expression of GPX4, FPN, and SLC7A11. This resulted in mitochondrial shrinkage in Schwann cells and loosened wrapping of the myelin sheath, as well as activation of neuroinflammation and oxidative stress. Inhibition of ferroptosis reversed these effects and alleviated demyelination and neuropathic pain. In conclusion, our study has clarified the impact of ferroptosis-induced demyelination in TN, providing a potential strategy for treating TN and offering new insights into the study of peripheral nerve demyelination diseases.

OBJECTIVE:The percutaneous balloon compression (PBC) procedure treats trigeminal neuralgia by compressing the Gasserian ganglion in Meckel's cave. On lateral fluoroscopy, a pear-shaped contrast-filled structure mainly consists of regenerative trigeminal rootlets, with a smaller, crescent-shaped, nonrenewable ganglion ('banana') at its base. To effectively minimize the risk of recurrence, it is crucial to apply precise and targeted pressure directly to the ganglion. To demonstrate that the bottom-boosted PBC process may effectively contribute to reducing recurrence. METHODS:From January 2019 to October 2023, a total of 371 consecutive cases of PBC were performed by the senior author (J.Z.) at XinHua Hospital. The cases were divided into two groups based on the operative strategy, excluding those with missing follow-up or unsuccessful pear shape achievement intraoperatively. Group Pear comprised those who achieved a typical pear shape using the traditional technique; Group Banana, included those who underwent adjustments of the balloon position after visualizing a pear shape, followed by retraction until a headless pear emerged. RESULTS:A total of 328 participants were ultimately enrolled in this study, comprising 92 individuals in group Pear and 236 in group Banana. The efficacy upon awakening from anesthesia was 95.7% in group Pear versus 99.2% in group Banana (P > 0.05), declining to 75.0% and 92.4%, respectively, one year later (P < 0.01). Immediate ipsilateral numbness rates were 60.9% in group Pear and 43.2% in group Banana (P < 0.01), decreasing to 10.9% and 9.7%, respectively, after one year (P > 0.05). CONCLUSIONS:A pear-shaped configuration indicates successful balloon entry into Meckel's cavity. To prevent recurrence and reduce complications, compression should focus on the base rather than the apex of the pear.

OBJECTIVE:The hypoglossal-facial and cervical-hypoglossal nerve anastomoses (HFCHA) technique addresses severe facial palsy after cerebellopontine angle (CPA) tumor resection. However, postoperative facial function recovery and tongue dysfunction vary significantly among patients. This study identifies prognostic factors influencing these outcomes. METHODS:We retrospectively followed up on 43 patients with facial palsy who underwent HFCHA for CPA tumor resection (July 2019-December 2022). The patients were divided into two groups based on their recovery of facial function or tongue function: the good recovery group and the poor recovery group; or the tongue dysfunction group and the normal tongue function group. Potential prognostic factors were evaluated using univariate and multivariable analyses. RESULTS:Patients with a duration of facial palsy less than 10.75 months may exhibit an increased likelihood of achieving improved facial function recovery following surgical intervention. Compared to individuals who engaged in longer postoperative tongue rehabilitation exercises, patients whose exercise duration was shorter than 4.5 months demonstrated a tendency towards experiencing tongue dysfunction after surgery. CONCLUSIONS:A shorter time interval between facial nerve injury and surgery helps with the recovery of facial palsy. Longer postoperative tongue rehabilitation exercises may also potentially alleviate tongue dysfunction.

Percutaneous balloon compression (PBC) is recognized as a simple, safe, and effective intervention for trigeminal neuralgia (TN) and has been widely adopted in clinical practice across China. However, variations in its application exist among different regions. To standardize procedural protocols and enhance clinical outcomes, a multidisciplinary panel of Chinese experts from pain medicine and neurosurgery collaboratively developed this clinical expert consensus. The consensus formulation involved a systematic literature review of major databases, including Wanfang and PubMed, among others, and focusing on high-quality evidence such as systematic reviews, meta-analyses, randomized controlled trials, expert consensus statements, and clinical guidelines. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework and structured consensus conference methods, the panel held iterative discussions and conducted voting sessions to finalize the recommendations. This document summarizes key aspects of PBC, including relevant anatomy, mechanisms of action, indications, contraindications, detailed operative techniques, and efficacy evaluation. It aims to serve as a practical reference for clinicians to standardize and optimize the use of PBC in the treatment of trigeminal neuralgia.

BACKGROUND:Microvascular decompression (MVD) is an effective nondestructive neurosurgical procedure for trigeminal neuralgia (TN). However, some patients may undergo surgery failure or experience pain recurrence, sparking debates on the need for reoperation. METHODS:We conducted a retrospective analysis of 103 cases of patients with primary TN who underwent redo MVD at our center between January 2020 and December 2022. Comparative prognostic assessments were performed by comparing these cases against a cohort of 348 patients who underwent primary MVD during the same study period. RESULTS:During the redo MVD cases, arachnoid membranes adhesions (80.6%) and Teflon adhesions with/without granuloma (86.4%) as well as remaining vascular compression (36.9%) were observed. After the reoperation, an immediate relief rate of 94.2% was observed. During a mean follow-up period of 17.4 ± 4.4 months, a long-term relief rate of 89.3% was achieved. Postoperative complications included 3 cases of persistent paresthesia, 1 case each of hearing loss, cerebrospinal fluid leak, and facial palsy. Ten cases without evident compression received nerve combing and all experienced immediate complete relief, with only 1 patient experiencing recurrence 9 months after surgery. Compared to the primary MVD group, the reoperation group had a higher average age, longer disease duration, and operating time (P < 0.05). However, there were no significant differences in immediate relief rate, long-term relief rate, or complications between the 2 groups. The main cause of persistent symptom was inadequate decompression, such as missing the offending vessel; while the recurrent was primarily due to Teflon adhesion or granuloma formation. CONCLUSIONS:The redo MVD for TN is equally efficacious and safe compared to the primary procedure, with an emphasis on meticulous dissection and thorough decompression. Additionally, nerve combing proves to be an effective supplementary option for patients without obvious compression.

ObjectiveMeige syndrome (MS) is an adult-onset segmental dystonia for which no satisfactory remedy currently exists. Our team developed a novel surgical approach called bilateral trigeminal/facial nerve combing (BTFC). This study aimed to evaluate the outcomes of patients who underwent BFTC (Clinical Trial Registry Number: ChiCTR2000033481).MethodWe assigned 22 patients with MS to undergo BTFC. The primary outcome was assessed using the movement subscale of the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS-M) at 12 months postoperatively. The second outcome was evaluated using the Medical Outcome Study (MOS) 36-item Short Form Health Survey (SF-36), the dysfunction subscale of the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS-D), and the sub-item scores of the BFMDRS-M. Safety outcomes included the House-Brackmann (HB) functional grading score and the visual analog scale (VAS) for facial numbness.ResultsAt the final follow-up at 12 months, the BFMDRS-M showed a mean improvement of 70.7% from baseline. Mean scores of the BFMDRS-M sub-motor (including the eyes, mouth, and speech/swallowing) improved by 65.6, 81.00, and 60%, respectively. The median score of the total BFMDRS-D score was 0.70 ± 1.17 compared with 1.86 ± 2.21 at baseline. There were no serious operative complications in this population. The quality of life of the patients significantly improved (P < 0.05).ConclusionBFTC has proven to be effective in relieving the symptoms of Meige syndrome. This novel surgical approach offers a new alternative treatment for patients who have failed to respond to medications, botulinum toxin injections, and deep brain stimulation (DBS).Clinical Trial Registrationhttps://www.chictr.org.cn/bin/project/edit?pid=54567, ChiCTR2000033481.

Background The percutaneous balloon compression (PBC) is a safe and simple treatment for trigeminal neuralgia. It works by compressing the Gasserian ganglion to block pain signals from the trigeminal nerve. To ensure effectiveness, it is important to focus the compression on the lower part of the balloon. Objective To validate the efficacy of a riveting technique, specifically pulling an inflated balloon, in order to apply enhanced compression on the ganglion. Methods To compare this novel technique with the conventional approach, a retrospective investigation was conducted on consecutive PBCs performed in our department between 2019 and 2022. For postoperative outcome assessment, efficacy was defined as achieving a VAS score of 0 or an improvement exceeding 5 points. Postoperative numbness was graded as none, mild, or severe based on its impact on daily life and tolerance level. Results Excluding cases with missed follow-up, a total of 179 participants were included in the study, and their follow-up period ranged up to 40 months. Postoperatively, symptomatic remission was achieved by 98.1% (52/53) of patients in the riveting technique group compared to 87.3% (110/126) in the conventional group (P<0.05). At the last follow-up period, with recurrence observed over time, the long-term efficacy of riveting and conventional groups were 94.3% and 74.6%, respectively (P<0.05). The majority of cases in both groups experienced ipsilateral facial numbness immediately following PBC, which appeared to diminish after 3 months in both groups without significant difference between them (P>0.05).

Background: As a simple and safe alternative intervention, percutaneous balloon compression (PBC) has been gradually adopted by a growing number of neurosurgeons to treat trigeminal neuralgia. A pear-shaped opacity observed fluoroscopically, which indicates full suffusion of Meckel's cave conducting sufficient pressure against Gasserian ganglion, is believed to be the key to its success. Sometimes, a bitten pear may appear due to bubbles in the balloon but is usually ignored. Objective: This study aims to investigate the effects of the bubbles on postoperative outcomes. Methods: Patient data were obtained from the consecutive cases undergoing PBCs in our department between 2019 and 2021. Among them, pain and numbness were used to assess the efficacy of PBC based on Barrow Neurology Institute (BNI) scoring system. It was defined as an effective outcome if the postoperative pain intensity grade was lower than II. And those with numbness grade > II were regarded as numb incidence. Results: We eventually recruited 59 cases, including 42 in full pear and 17 in bitten pear groups with follow-up time up to 44 months. The early effective rates were 95.2% and 82.4%, respectively (p > 0.05), which turned to 88.1% and 52.9% during the last follow-up period (p < 0.01). This result indicated that the bitten pear gave rise to a significantly higher recurrence. In terms of numbness, there was no significant difference. Conclusion: Gas does not yield enough pressure as liquid, and cannot exert enough pressure to the semilunar ganglion. Therefore, air evacuation should not be ignored before injection.

OBJECTIVE Hypoglossal-facial nerve anastomosis (HFA) is the most commonly used surgical treatment for severe facial palsy that does not respond to conservative treatments. A major complication of HFA is the loss of tongue function. The authors aimed to evaluate whether anastomosing the transected hypoglossal nerve using the ramus descendens hypoglossi could prevent tongue deviation and dysfunction in patients undergoing HFA. METHODS In this randomized trial, adult patients with severe peripheral facial palsy (House-Brackmann grade V or VI) who did not respond to at least 6 months of conservative treatment were randomized at a 1:1 ratio to undergo either HFA alone (control group) or HFA plus anastomosis between the hypoglossal nerve and descendens hypoglossi (intervention group). The primary endpoint was tongue deviation angle at 12 months. Key secondary endpoints included tongue disability (chewing difficulty, swallowing defect, and articulation defect), tongue disability index (TDI; range 1–4, with a higher score indicating more severe disability), and facial nerve function. RESULTS Twenty patients were enrolled (10 in each group). At 12 months, the tongue deviation angle was significantly lower in the intervention group than in the control group (7.8° ± 5.1° vs 23.6° ± 9.6°, p < 0.001). Although not statistically significant, the intervention group had lower rates of chewing difficulty (1/10 vs 3/10, p = 0.58), swallowing defect (1/10 vs 5/10, p = 0.14), and articulation defect (2/10 vs 6/10, p = 0.17). TDI was significantly lower in the intervention group (1.5 ± 0.6 vs 2.5 ± 0.3, p < 0.001). The percentage of the patients achieving House-Brackmann grade II or III was 80% in each group. CONCLUSIONS Anastomosis of the descendens hypoglossi to the transected hypoglossal nerve attenuated tongue deviation in patients undergoing HFA for facial palsy, without compromising facial nerve function. Clinical trial registration no: ChiCTR2000034372 (Chinese Clinical Trials Registry).

Background: Hypoglossal-facial nerve anastomosis (HFA) is the most commonly used surgical treatment for severe facial palsy that does not respond to conservative treatments. A major complication of HFA is the loss of tongue function. Anastomosing the first cervical (C1) nerve to hypoglossal nerve could, in theory, salvage the hypoglossal nerve.Methods: In this randomised trial, adult patients with severe peripheral facial palsy (House-Brackmann grade of V or VI) that did not respond to at least 6 months of conservative treatment were randomised at a 1:1 ratio to undergo either HFA or simultaneous hypoglossal-facial and cervical-hypoglossal anastomoses (HFCHA). The primary end point was tongue deviation angle at 12 months. Key secondary end points included tongue disability (chewing difficulty, swallowing defect and articulation defect) and facial nerve function.Findings: A total of 20 patients were enrolled (10 in each group). At 12 months, tongue deviation angle was 23·6° ± 9·6° in the HFA group versus 7·8° ± 5·1° in the HFCHA group (P<0·001). The rate of chewing difficulty, swallowing defect and articulation defect was 3/10, 5/10 and 6/10 in the HFA group versus 1/10, 1/10 and 2/10 in the HFCHA group. Percentage of the patients achieving House-Brackmann grade III or II was 80% in both groups.Interpretation: Simultaneous anastomosis of the C1 nerve to hypoglossal nerve attenuated tongue deviation and dysfunction in patients undergoing HFA for severe facial palsy, without compromising facial nerve function.Trial Registration: Registered at the Chinese Clinical Trials Registry (ChiCTR2000034372; July 3, 2020).Funding: National Natural Science Foundation of China, Science and Technology Commission of Shanghai Municipality, Shanghai Shen-Kang Hospital Development Center and Shanghai Leading Talent Program.Declaration of Interest: We declare no competing interests.Ethical Approval: The trial protocol was approved by the institutional review boards of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the Fifth Affiliated Hospital of Zhengzhou University (included in the original protocol as a participating center, but only referred patients and not actually performed surgery or follow-up). The trial was performed in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants prior to enrollment.

Objective Although endoscopic drill has the advantages in manipulation and hemostasis, whose low efficiency and blurred vision reduce the efficacy of lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD). The present study was designed to evaluate the safety and efficacy of full-visualized trephine/osteotome in the LE-ULBD surgery for severe lumbar stenosis. Methods Fifty-seven severe lumbar stenosis patients who underwent LE-ULBD between January 2020 to January 2023 were enrolled, who were divided into drill and visualized trephine groups. The medical records including demographics, operative duration, intraoperative electrophysiological findings, postoperative hospital stay or hospital stay, postoperative outcomes and complications were retrospectively reviewed and analyzed. Results A total of 57 patients included 15 in drill and 42 in trephine group were enrolled in the study. There was significant difference in the pre- and postoperative visual analogue scale and Oswestry Disability Index scores in both groups (p < 0.05). The mean operative duration in the trephine group (101.05±12.18 minutes) was shorter than that in the drill group (134.67±9.68 minutes) (p < 0.05). There was no statistical difference between the 2 groups in electrophysiological monitoring, posthospital stays, postoperative outcomes and complications. Abnormal free-electromyography (EMG) were recorded in 2 (13.3%) and 5 patients (11.9%) in the drill and trephine group. Intraoperative somatosensory evoked potential changes occurred in 3 (20%) and 3 patients (7.1%) in the drill and trephine group and all patients recovered immediately when surgery ended. No serious complications and recurrence occurred in all the patients. Conclusion Full-visualized trephine/osteotome has been approved to be convenient, safe and efficient in our study, which combined with translaminar inside-out technique and EMG monitoring especially free-EMG may offer a new choice in LE-ULBD surgery for lumbar stenosis patients.