Background: Meige's syndrome severely impacts quality of life. Current treatments struggle to balance cost, risk, and effectiveness. Methods: Patients with blepharospasm were treated with facial nerves partial radiofrequency ablation guided by CT. Treatment efficacy, complications, and recurrences were evaluated during follow-up. Results: 116 facial nerves in 58 patients with Meige's syndrome were treated using CT guidance. The average temperature at the end of radiofrequency treatment was 77.93 +/- 9.8 degrees C, and the procedure lasted an average of 30.79 +/- 7.69 min. Spasms stopped after treatment, but mild facial paralysis remained. Follow-ups ranging from 12 to 57 months showed that facial paralysis improved in an average of 3.12 +/- 0.94 months. Nine patients had unilateral recurrence within 6-13 months, and three had bilateral recurrence at 14, 18, and 22 months. Conclusions: Partial radiofrequency ablation of the facial nerve through percutaneous access to the bilateral stylomastoid foramen using CT navigation is an effective, safe, promising treatment for blepharospasm in Meige's syndrome patients. (c) 2024 Asian Surgical Association and Taiwan Society of Coloproctology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).

This retrospective study examined the clinical outcomes and complications in 6 cases of compound Meige’s syndrome, presenting with blepharospasm and masticatory muscle spasm, following treatment with CT-guided radiofrequency ablation targeting bilateral facial nerves and mandibular branches of the trigeminal nerve. After the operation, the symptoms of eyelid spasm and masticatory muscle spasm resolved, but mild facial paralysis and numbness of mandibular nerve innervation persisted. Follow-up for 4–28 months showed that the symptoms of facial paralysis resolved within 2–5 (3.17 ± 0.94) months after the operation, whereas the numbness in the mandibular region persisted, accompanied by a decrease in masticatory function. During the follow-up period, none of the 6 patients experienced a recurrence of Meige’s syndrome. These findings suggest that CT-guided radiofrequency ablation of the bilateral facial nerve and mandibular branches of the trigeminal nerve may offer a promising approach to treating compound Meige’s syndrome.

Background: The classic percutaneous balloon compression (PBC) technique is used to complete an operation under the guidance of C-arm radiography under general anesthesia, making communication with patients during the operation impossible. It is not accurate or objective to predict the classic technique's curative effect solely by determining whether the projection of the x-ray lateral image of the filled balloon is pear-shaped. Objectives: This study aimed to upgrade classic PBC to awake computed tomography (CT)-guided PBC technology under conscious local anesthesia and analgesia monitoring. Study Design: Prospective clinical study. Setting: Department of Anesthesiology and Pain Medical Center, Jiaxing, People's Republic of China. Methods: Puncture was designed and guided by CT scanning, and the curative effect was assessed by asking the patients about what they are feeling during the operation. Results: CT can design the puncture path and accurately guide puncture, observe the position and shape of the balloon through 3-dimensional reconstruction during the operation, and judge the curative effect according to the patient's chief concern. Limitations: Local anesthetic analgesia is not perfect, resulting in some patients experiencing pain during surgery. Conclusions: PBC can be completed under conscious local anesthesia and analgesia. Its curative effect and operative end standard can be determined according to the patient's chief concern. Under CT guidance, the puncture path can be designed to complete an accurate puncture and to intuitively understand the position and shape of the balloon

原发性面肌痉挛(hemifacial spasm,HFS)是第七对颅神经-面神经较常见的疾病,主要表现为一侧面部不自主抽搐,出现患侧睁眼困难、口角歪斜、颈肌颤动等症状,严重影响患者工作生活[1].本研究探讨经茎乳孔穿刺射频治疗原发性面肌痉挛,在前期研究中证实,经由下颌角入路穿刺路径更贴近面神经主干,治疗效能更佳[2],但穿刺路径设计相对繁琐,故引入术前3D打印导航模板,进行该入路的进一步优化,现报道如下.

Neuropathic pain is the pain triggered or caused by primary damage and dysfunction of the nervous system. Its pathogenesis is complex, involving changes in ion channel function, abnormal action potential generation and expansion, and central and peripheral sensitization. Therefore, it has always been the most intractable problem in clinical pain diagnosis and treatment, and there are many kinds of treatment methods. In addition to various oral drugs, nerve block, pulsed radiofrequency, radiofrequency ablation, central nerve electrical stimulation, peripheral nerve electrical stimulation, intra-thecal infusion system, craniotomy nerve decompression or carding, the dorsal root entry zone disfigurement, etc. various methods have mixed efficacy. So far, radiofrequency ablation of peripheral nerves is still the most simple and effective means for the treatment of neuropathic pain. In this paper, the definition, clinical manifestations, pathological mechanism and the treatment methods of radiofrequency ablation of neuropathic pain were expounded, in order to provide reference for related clinicians in radiofrequency ablation.

Objective: To evaluate the efficacy of CT-guided partial radiofrequency ablation of bilateral responsible cranial nerves in the treatment of Meige syndrome. Methods: The Clinical data of 56 patients with Meige syndrome in the Department of Pain Medicine, Affiliated Hospital of Jiaxing University from June 2019 to January 2023 were retrospectively analyzed [19 males and 37 females, aged 42-76 (58.6±8.3) years], including 51 cases of blepharospasm, 3 cases of oromandibular dystonia and 2 cases of blepharospasm concomitant with oromandibular dystonia. CT-guided partial radiofrequency ablation of bilateral responsible cranial nerves was performed on different types of Meige syndrome. And the efficacy and complications of the technique were observed. Results: Fifty-one patients with blepharospasm Meige syndrome underwent CT-guided radiofrequency of facial nerve through bilateral stylomastoid foramen punctures, the symptoms of blepharospasm disappeared completely, leaving bilateral mild and moderate facial paralysis symptoms. Three patients with oral-mandibular dystonia underwent CT-guided radiofrequency therapy by bilateral foramen ovale puncture of mandibular branches of trigeminal nerve, masticatory muscle spasm disappeared, the patients had no difficulty opening the mouth, and the skin numbness in bilateral mandibular nerve innervation area was left. Two cases of Meige syndrome with blepharospasm concomitant with oromandibular dystonia were treated by radiofrequency of facial nerve and mandibular branch of trigeminal nerve, and all symptoms disappeared. The patients were followed up for 1-44 months after the operation, and the symptoms of mild and moderate facial paralysis disappeared at (3.2±0.8) months after the operation, but the numbness did not disappear. Three patients with blepharospasm recurred at the 14, 18 and 22 months after the operation, respectively, while the rest cases did not recur. Conclusions: According to different types of Meige syndrome, CT-guided partial radiofrequency ablation of responsible cranial nerves can effectively treat the corresponding type of Meige syndrome. The complications are only mild and moderate facial paralysis which can be recovered, and/or skin numbness in the mandibular region.

BACKGROUND:Hemifacial spasm (HFS) is characterized by progressive, paroxysmal, and involuntary convulsions on one side of the face. We have conducted in-depth exploration on the puncture approach through the mandibular angle, which is an important supplement to the first 2 approaches (i.e., premastoid approach and the postmastoid approach), especially for patients who cannot find a suitable way before and after the mastoid process. OBJECTIVES:To investigate the effect of computed tomography (CT)-guided percutaneous mandibular angle radiofrequency thermocoagulation (RFT) of facial nerve through the stylomastoid foramen in treating HFS. STUDY DESIGN:A retrospective, observational study. SETTING:Pain Department, Jiaxing and Hangzhou, China. METHODS:A total of 89 patients with HFS who underwent CT-guided RFT in the Pain Department of Zhejiang Integrated Traditional Chinese and Western Medicine Hospital and the Pain Department of Jiaxing First Hospital, from June 2020 to June 2022, were retrospectively analyzed, including 29 men and 60 women, aged 34~88 (59.8 ± 11.1). They were divided into 3 groups: anterior mastoid approach group (Group A, n = 38), posterior mastoid approach group (Group P, n = 26), and mandibular angle approach group (Group M, n = 25), according to the different puncture approaches. Puncture time, minimum stimulating current triggering facial muscle twitches, temperature at the end of RFT and duration time of RFT at this temperature, and total treatment time, as well as degree of facial paralysis and complications one-day postoperation, were compared among the 3 groups. RESULTS:The puncture times (mean ± SD) of Group A, Group P, and Group M were (30.63 ± 4.88), (31.35 ± 5.89), and (35.08 ± 5.76), respectively, and the differences were statistically significant (P = 0.006). The puncture time of Group M was longer than that of Groups A and P (P < 0.05). The minimum stimulating current triggering facial muscle twitches in the 3 groups were (0.49 ± 0.16), (0.43 ± 0.14), and (0.28 ± 0.09), respectively, with a statistically significant difference (P = 0.000). The minimum stimulation current in Group M was less than that in Groups A and P (P < 0.05). The temperature at the end of RFT of the 3 groups was (78.29 ± 7.91), (76.54 ± 8.10), and (66.60 ± 8.00), respectively, and the differences were statistically significant (P < 0.001). The temperature of Group M was lower than Groups A and P (P < 0.05). There were no significant differences among the 3 groups in the total operation time or the degree of facial paralysis one-day postoperation (P > 0.05). No hematoma, infection, hearing impairment, or other complications were reported in any patients. LIMITATIONS:The nonrandomized nature, small sample size, and retrospective design are limitations of this study. CONCLUSIONS:CT-guided RFT through the stylomastoid foramen is an effective treatment of HFS. Compared to the poster and anterior mastoid approaches, the mandibular angle approach was found to be more effective in terms of reduced minimum stimulating current and reduced-end RFT temperature, which means fewer potential complications to the patient postsurgery. KEY WORDS:Hemifacial spasm, radiofrequency thermocoagulation, stylomastoid foramen, CT-guided.

目的:探讨CT引导下颅外非半月神经节射频消融治疗三叉神经痛技术的临床应用效果。方法:横断面研究。纳入2013年1月—2022年12月嘉兴市第一医院、海宁市第二人民医院和杭州市红十字会医院疼痛科原发性三叉神经痛患者1 213例，其中男722例、女491例，年龄31~103（64.3±7.6）岁。疼痛位于三叉神经第Ⅰ支、第Ⅱ支、第Ⅲ支、第Ⅰ+Ⅱ支、第Ⅱ+Ⅲ支、第Ⅰ+Ⅱ+Ⅲ支者分别为188、312、447、63、176、27例，均接受颅外非半月神经节射频治疗，分别在CT引导下经皮穿刺至患侧眶上孔、圆孔、卵圆孔、眶上孔+圆孔、圆孔+卵圆孔和眶上孔+圆孔+卵圆孔，电生理测试确认后对责任神经分支给予95 ℃、180ｓ射频消融治疗。疗效评估：以术后发作性疼痛消失且至少持续1个月不发作为治愈，以术后仍有疼痛发作但发作时疼痛视觉模拟评分法（VAS）评分较术前降低25%以上为有效，且治疗有效患者术后第3天再次行射频消融治疗后疼痛发作消失者仍记为治愈；记录术中、术后并发症；观察三叉神经痛复发率，以治愈1个月以上再次出现发作性三叉神经痛为复发。结果:本组1 213例均治愈，患者原疼痛区均遗留明显的皮肤感觉麻木：其中1 153例经一次射频消融治疗后痊愈，术后第2天未再出现发作性疼痛；另60例一次射频消融治疗后第2天仍有疼痛发作，但发作时VAS评分由术前的5~9（6.43±2.31）分下降至4~6（3.72±0.46）分，下降幅度均>25%，显示治疗均有效，于术后第3天予以再次射频消融治疗后均治愈。全组患者围术期均无心、脑血管意外事件发生，无穿刺部位或颅内感染，无非疼痛区域感觉减退；其中94例术后面部肿胀，经序贯冷、热敷3 d肿胀渐消退。原疼痛累及第Ⅲ支的650例患者术后均有不同程度的张口困难和咀嚼无力，患侧颊、舌黏膜感觉减退，上下牙列对位稍不齐。本组1 213例患者术后随访0.5~10年，1年、3年、5年、10年复发率分别为7.3%（79/1 082）、19.2%（132/687）、31.8%（125/393）、51.4%（38/74）。结论:将三叉神经痛的射频消融治疗靶点由颅内半月神经节转移至各分支出颅孔道是安全、可行的，且临床疗效较好。

Objective: This study aimed to analyze the effects of transcutaneous electrical acupoint stimulation (TEAS) on the immune function in patients with pulmonary tuberculosis (PT) and the inflammatory response following one lung ventilation surgery by comparing the levels of inflammatory mediators, such as tumor necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6), and interleukin 8 (IL-8); T lymphocyte subsets, including CD3(+), CD4(+), CD8(+), and CD4(+)/CD8(+)+ cells; and natural killer cells (NK cells). Methods: We randomly divided 62 patients who underwent general anesthesia for thoracotomy into two groups: TEAS and sham TEAS. Patients in the TEAS group underwent bilateral acupoint electrical stimulation at the Hou-Xi, Zhi-Gou, Nei-Guan, and He-Gu acupoints from 30 min before anesthesia induction until the end of surgery. TEAS was continuously maintained throughout the procedure with a dilatational wave at 2/100 Hz. Those in the sham TEAS group underwent the same management but without stimulation, and the anesthesia induction and maintenance methods were the same in both groups. Venous blood was drawn to monitor inflammatory mediators and lymphocyte subsets before anesthesia induction and 5 days after the surgery. Results: There was no statistical difference in the general conditions between the two groups (P > 0.05). Before anesthesia induction, the levels of inflammatory factors (IL-6, IL-8, and TNF-alpha), lymphocyte subsets (CD3(+), CD4(+), and CD4(+)/CD8(+)), and NK cells did not statistically differ between the two groups (P > 0.05). Compared to the sham TEAS group, the levels of IL-6, IL-8, TNF-alpha, and CD8(+) were lower in the TEAS group, while those of CD3(+), CD4(+), CD4(+)/CD8(+), and NK cells were higher; however, only the change in TNF-alpha was significant (P < 0.05). Conclusion: TEAS at the Hou-Xi, Zhi-Gou, Nei-Guan, and He-Gu acupoints at 2 Hz/100 Hz can reduce the inflammatory response during one-lung ventilation but has no significant effect on the immune function in patients with tuberculosis.

Abstract BackgroundZoster-associated pain treatment is considered to be difficult worldwide. Presently, the primary treatment methods include oral medications, nerve blocks, nerve radiofrequency (RF), electrical stimulation, etc. We report a peculiar course transition and corresponding treatment for a case of severe herpes zoster-Neuralgia in the Head and Face.Case PresentationA 59 year-old Chinese male presented with a severe and variable zoster-associated pain in the head and face. The chief complaint on admission was pain on the right side of his head and face after herpes zoster for 32 days. After pulse RF (PRF) and multiple supraorbital nerve blocks combined with oral analgesics were administered to the patient, the patient rated his resting pain as 4 on the numerical rating scale (NRS) and his paroxysmal pain as 9–10. Specifically, his pain shifted from the right side of his forehead to the right side of his nasal cavity to the right occipital region. Finally, a percutaneous micro balloon compression of the trigeminal ganglion and RF of the second trigeminal nerve, supraorbital nerve, and cervical nerve root were performed consecutively. All the pain was relieved significantly after surgery. Seven months later, there was no recurrence of pain and no oral drugs were taken.Conclusion On the premise of not damaging motor function, RF should be used decisively for patients suffering from zoster-associated pain, which is a serious condition and resistant to various treatments.

Chinese grading scales of facial paralysis and facial spasm are formulated in this paper by referring to the visual analogue scale system for pain, so as to realize the desire that Chinese people should have their own grading standards, also to provide an assessment tool for realizing the rapid and accurate evaluation of termination during the process of radiofrequency ablation therapy and for avoiding the occurrence of severe facial paralysis complications by excessive radiofrequency ablation.

Blepharospasm refers to involuntary contraction of the orbicularis in both eyes, causing difficulty in opening the both eyes, and is currently considered a local dystonia disorder, one type of Meige's syndrome (MS). This paper reports one patient with blepharospasm was successfully treated by facial nerve radiofrequency via bilateral stylomastoid foramen under the guidence of CT, which providing a new method for the treatment of this disease.

BackgroundMeige’ s syndrome, a rare form of dystonia, lacks effective treatment. The purpose of this study was to determine the effects of CT-guided percutaneous extracranial radiofrequency ablation of the facial and/or trigeminal nerves in the treatment of Meige’s syndrome.MethodsA total of 10 patients were enrolled in this study, with the numbers of blepharospasm dystonia syndrome (BDS), oromandibular dystonia syndrome (ODS), and blepharospasm combined with oromandibular dystonia syndrome (B-ODS) being 7, 1, and 2, respectively. BDS patients underwent radiofrequency ablation of the bilateral stylomastoid foramen facial nerve; ODS patients underwent radiofrequency ablation of the bilateral foramen oval trigeminal mandibular branch, and B-ODS patients underwent radiofrequency ablation of the bilateral stylomastoid foramen facial nerve and foramen oval trigeminal mandibular branch. The therapeutic effects and complications were observed.ResultsAll 10 patients in this series experienced improved Meige’s syndrome-related symptoms after extracranial radiofrequency ablation of the cranial and/or mandibular branches of the extracranial trigeminal nerve. Adverse events included class II–III facial paralysis and/or mandibular skin numbness. Two patients had recurrences at the 18th and 22nd months postoperatively, respectively; the other patients were being followed up.ConclusionThese results shown that CT-guided radiofrequency ablation of bilateral stylomastoid foramen facial nerve and/or oval foramen trigeminal mandibular branch can effectively treat the corresponding types of Meige’s syndrome. According to preliminary observations, the therapeutic effect may last more than 18 months.

目的 探讨等离子髓核成形术联合臭氧消融术在腰椎间盘突出症(LDH)患者中的疗效.方法 选取2017年6月至2019年6月期间就诊于本院疼痛科的LDH患者65例,数字随机法分为2组:B组(对照组,n=32)予等离子髓核成形术治疗,A组(观察组,n=33)在对照组基础上行臭氧消融治疗,分别记录两组患者术前1?d、术后3?d、术后1个月、术后3个月的数字疼痛分级法(NRS)评分及日本骨科协会(JOA)评分,观察比较两组患者疗效.结果 两组患者在性别、年龄、发病节段数、椎间盘突出位置、术前NRS评分、术前JOA评分、术后第3天的NRS评分、住院时长方面无统计学差异(P>0.05).与B组相比,A组NRS评分在术后1个月及术后3个月均较低(P<0.05),A组JOA评分在术后任意时间均明显改善(P<0.05).结论 等离子髓核成形术联合臭氧消融治疗LDH较单纯等离子髓核成形术中远期疗效更佳,且有助于患者日常生活能力的改善.

BACKGROUND:Post-herpetic neuralgia (PHN) is a typical neuropathic pain. Conventional oral analgesics and nerve block therapy can only obtain temporary analgesia in many cases. This study summarized the clinical effect of CT-Guided intervertebral foramen puncture and radiofrequency thermocoagulation through the superior margin of costotransverse joint for the treatment of refractory PHN in the superior thoracic segment.OBJECTIVES:To observe the efficacy of CT-Guided intervertebral foramen puncture and radiofrequency thermocoagulation (RFT) treatment of refractory PHN in the T1 ~ T3 spinal innervation area.STUDY DESIGN:A retrospective, observational study.SETTING:Pain department, Jiaxing and Hangzhou, China.METHODS:Thirty-six patients with intractable superior thoracic PHN were admitted to the Pain Department. After the positioning image of CT was taken by prone, the upper thoracic segment was scanned in axial position with the layer thickness of 3 mm of spinal model.The puncture path was designed by selecting the slice of the foramen and costotransverse joint from the obtained images. The needle was inserted to the corresponding foramen. After confirmation by high and low frequency current stimulation tests, the RFT was performed at 90°C for 180s. A numeric rating scale (NRS) for pain was recorded before surgery, 2 hours, 1 week, 4 weeks and 8 weeks after surgery and the mental state was assessed with the SF-36 clinical questionnaire before surgery, 4 weeks and 8 weeks after surgery.RESULTS:Following RFT intervention the measured pain NRS significantly decreased after 2 hours, 1 week, 4 weeks and 8 weeks (P < 0.01). SF-36 scores in all categories increased 4 and 8 weeks after the operation (P < 0.01). No serious adverse effects were reported during the study period and no hypoxemia was found under intraoperative nasal catheter oxygen inhalation.LIMITATIONS:Limitations of this study include the small sample size, and nonrandomized retrospective design.CONCLUSION:CT-Guided intervertebral foramen puncture and RFT through the superior margin of the costotransverse joint can effectively improve refractory PHN in the superior thoracic segment with good safety.

Painful tic convulsif syndrome is ipsilateral facial trigeminal neuralgia combined with hemifacial spasm, which is relatively rare in the clinic. Microvascular decompression is currently considered to be an effective treatment. We report extracranial radiofrequency treatment of painful tic convulsif syndrome under local anesthesia, a technique which provides a safer and more economical treatment for this kind of patient. We report a case of painful tic convulsif syndrome which was treated with extracranial radiofrequency therapy of the trigeminal nerve and facial nerve. After operations, the symptoms of pain and spasm were relieved immediately, but the right facial numbness and facial paralysis (House–Brackmann grade III) were left. The facial paralysis was completely relieved after 3 months of follow-up, and there was no recurrence of trigeminal neuralgia or hemifacial spasm after 35 months. Painful tic convulsif syndrome is a combination of ipsilateral facial trigeminal neuralgia and hemifacial spasm, which is relatively rare in the clinic. So far, only one treatment method of microvascular decompression has been reported for the disease. We report the first case of CT-guided extracranial radiofrequency therapy for painful tic convulsif syndrome. Extracranial radiofrequency therapy can provide safe and economical treatment for patients with painful tic convulsif syndrome.

Primary hemifacial spasm is a motor disorder of facial muscles related to facial nerve. During the attack, the facial muscles present irregular and involuntary clonus, which can be induced or aggravated by emotional excitement, mental tension and random facial movement, seriously affecting daily work and life. The pathogenesis, diagnosis, differential diagnosis and treatment of the primary hemifacial spasm have been studied extensively in recent years. This article reviews the progress in these aspects.

Objective: To investigate the efficacy of CT-guided percutaneous mandibular angle radiofrequency thermocoagulation (RFT) of facial nerve through stylomastoid foramen for the treatment of hemifacial spasm. Methods: A total of 82 patients with primary facial spasm who underwent CT-guided RFT in the Department of Pain Medicine of Zhejiang Integrated Traditional Chinese and Western Medicine Hospital and Department of Pain Medicine of the First Hospital of Jiaxing from January 2019 to June 2021 were retrospectively analyzed, including 27 males and 55 females, aged 24-85 (59±11) years. All patients were divided into three groups according to the different puncture approaches: anterior mastoid approach group (Group A, n=35), posterior mastoid approach group (Group P, n=25) and mandibular angle approach group (Group M, n=22). The puncture time, the minimum stimulating current inducing the twitch of facial muscles on the affected side, the temperature at the end of RFT and the duration of RFT at this temperature, the total treatment time, as well as the degree of facial paralysis and complications 1 day after operation were compared among the three groups. Results: The puncture time of the Group A, Group P and Group M was (31.0±4.9) min, (31.9±6.5) min and (35.3±5.9) min, respectively, and the difference was statistically significant (P=0.020). The puncture time of the Group M was longer than that of the Group A and P (both P<0.05). The minimum stimulation current inducing the twitch of the affected facial muscle in the three groups was (0.5±0.2) mA, (0.4±0.1) mA and (0.3±0.1) mA, respectively, with a statistically significant difference (P=0.000). The minimum stimulation current in the Group M was less than that in the Group A and P (both P<0.05). The temperature at the end of RFT of the three groups was (78.6±8.1) ℃, (76.6±8.3) ℃ and (67.0±8.4) ℃, respectively, and the difference was statistically significant (P<0.001). The temperature of the Group M was lower than that of the Group A and P (both P<0.05). There were no significant differences among the three groups in the duration of RFT at the final temperature, the total treatment time, and the degree of facial paralysis 1 day after operation (all P>0.05). No hematoma, infection, hearing impairment and other complications occurred in all patients. Conclusion: CT-guided percutaneous RFT through stylomastoid foramen is efficacious in the treatment of hemifacial spasm, and the mandibular angle approach provides better performance.

Facial nerve block technique can be used to treat a variety of facial nerve dysfunctional diseases. Based on the anatomy and function of the facial nerve, this expert consensus summarizes the indications, contraindications, operation methods, prevention and treatment of complications and precautions of facial nerve block, so as to provide guidance for clinicians to carry out the treatment of facial nerve block.

BACKGROUND:Hemifacial spasm (HFS) is mainly characterized by paroxysmal involuntary twitches of one side of the facial muscles. We developed an awake CT-guided percutaneous puncture of the stylomastoid foramen for radiofrequency ablation (RFA) therapy for the treatment of hemifacial spasm and successfully used it in our clinic.OBJECTIVE:We aimed to compare anterior or posterior mastoid approaches in CT-guided percutaneous RFA at the stylomastoid foramen for the treatment of HFS.STUDY DESIGN:Prospective, clinical research study.SETTING:Department of Anesthesiology and Pain Medical Center, Ningbo, China.METHODS:Sixty-eight patients with HFS were recruited. They were divided into 2 groups: anterior mastoid approach and posterior mastoid approach. With the patient were under minimal sedation, a radiofrequency  needle was used to reach the stylo-mastoid foramen on the affected side by an anterior approach or posterior approach; the facial nerve was localized using a low-frequency stimulation current. Ablation stopped when the patient's hemifacial contracture resolved. The puncture depth, angle, intraoperative and postoperative complications, and the short-term and long-term efficacy of the 2 puncture approaches were recorded.RESULTS:The HFS disappeared completely in 37 and 24 cases of the anterior and posterior group, but cases of both groups exhibited a House-Brackmann Facial Paralysis Scale Grade II or Grade III. During one-24 months of follow-up, 5 cases and 3 cases recurred respectively in the two groups. After 6 months of follow-up, the facial paralysis symptoms of patients in both groups disappeared.CONCLUSION:There was no difference in the operation time or efficacy between the 2 approaches. The anterior mastoid approach is easier to perform and is recommended based on our experience.