• The Korean Journal of Pain
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• v.23 no.2
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• pp.137-141
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• 2010

Background: Facet joint have been implicated as a source of chronic low back pain. Radiofrequency denervation has demonstrated the most solid evidence. To increase safety and efficacy of treatment, computed tomography (CT) guidance injection has been used in several disease. The purpose of this study was to evaluate the efficacy of CT-guided radiofrequency rhizotomy in the treatment of facet joint pain. Methods: A total of 40 patients were randomized to undergo radiofrequency facet joint denervation under CT guidance or C-arm guidance. All patients were examined visual analogue scale (VAS) score before treatment, 1 month, and 3 months after treatment. Results: The VAS in both groups showed significant improvement over the 1-month interval. No significant difference in the VAS score among the group was observed. Conclusions: In this study there was no significant difference between CT guidance lumbar rhizotomy and C-arm guidance lumbar rhizotomy. Therefore CT-guided radiofrequency denervation of the lumbar facet joint was a minimally invasive technique that appears effective.

• Journal of Korean Neurosurgical Society
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• v.29 no.1
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• pp.66-71
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• 2000

Objective : There are many treatment modalitis in management of idiopathic trigeminal neuralgia. In the secondary trigeminal neuralgia, there has been only sporadic reports of the etiology. Authors report the treatment result of secondary trigeminal neuralgia with percutaneous radiofrequency rhizotomy. Methods : During last ten years, 129 trigeminal neuralgias were treated by percutaneous radiofrequency(RF) rhizotomy by authors. Among them, nine patients were secondary trigeminal neuralgias. These patients refused treatment for the primary cause and only wanted pain control. The offending lesions were three arachnoid cysts, six tumors. The mean age was 47.8 years and the mean duration of follow-up was 6.2 years. The right V2,3 distribution was most prevalent area of pain. Authors used the conventional Hartel's anterior approach and straight electrode for RF lesion generation. Result : The early result was satisfactory. Eight of nine patients became free of pain and one patient needed minimal dose of carbamazepine. The overall pain control was 100%. There was no mortality or morbidity for initial RF rhizotomy. During follow-up, four patients showed recurrence of pain(44%). Among these, two underwent repeated RF rhizotomy and became free of pain. The other two were controlled with medical management. Conclusion : These results indicate that the percutaneous RF rhizotomy is effective means of pain control. Overall recurrence was somewhat higher than that of idiopathic trigeminal neuralgia. Even with recurrence, however, repeated RF rhizotomy seems to be effective method of control of pain in these cases.

• The Korean Journal of Pain
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• v.4 no.2
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• pp.196-199
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• 1991

Efforts from many different approaches have been made to manage malignant sacral pain that commonly occurs in cancers from pelvic origin. Radiofrequency thermocoagulation provides a safe method of achieving long standing relief of intractable pain without some of the objectable side effects associated with other forms of chemical or surgical therapy. Radiofrequency sacral rhizotomy is a new method for the relief of the sacrococcygeal pain. We report a case in which we managed a patient with malignant sacrococcygeal pain with radiofrequency thermocoagulation.

• Journal of Korean Neurosurgical Society
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• v.40 no.6
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• pp.419-422
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• 2006

Objective : Radiofrequency facet rhizotomy[RFFR] has been widely performed for treatment of chronic neck pain caused by cervical dorsal ramus syndrome[CDRS]. To evaluate the therapeutic effectiveness of RFFR in the patients with CDRS, we analyzed patients with various cervical pathologic conditions. Methods : The therapeutic results in forty-four patients who underwent RFFR for CDRS from January, 2000 to December, 2002 were analyzed according to the underlying pathologic conditions causing CDRS. The pathologic conditions were sprain [33 cases], herniated nucleus pulposus [6], foraminal stenosis [4], and compression fracture [1]. The therapeutic results were evaluated one month after the operation and graded as excellent, good, fair of poor. Treatments were considered successful if the therapeutic results were graded as either excellent of good. Results : The overall success rate in all patients was 72.7%. The success fate for treatment of cases with cervical sprain was 87.9%, but treatment of cases with herniated nucleus pulposus, foraminal stenosis, and fracture showed unsatisfactory results [mean success rate was 27.3%]. Some patients complained of transient hypesthesia [4 cases] of transient dull pain at the electrode insertion sites [2 cases]. Conclusion : RFFR is an effective and safe treatment for CDRS caused by cervical sprain, regardless of the patient's age, the duration of the symptoms, and the presence of radiating pain.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.127-129
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• 1998

Intractable chest and abdominal wall pain responds well to root surgery. But it is better to perform this procedure less invasively with less complications. Cryoanalgesia has been developed to relieve several neurogenic pain without causing irrversible nerve damage. Well-selected percutaneous cryoablative procedure could be one of the technique of choice for some chronic pains because it has the advantage of easy application without any remarkable side effect. We did percutaneous cryoneurolysis of the spinal nerve root at the thoracic level to treat one patient with severe cancer pain on the chest wall(T4, 5, and 8 dermatomes) after successful percutaneous radiofrequency T6 and T7 posterior root rhizotomy. This procedure was performed under fluoroscopic guidance. We advanced 2 mm cryoprobe to the posterior, superior aspect of vertebral foramen on lateral view until the patient felt paresthesia. 3 times of 2 minutes freezing was applied to each spinal nerve root. The patient got immediate pain relief without any side effect.

• Journal of Korean Neurosurgical Society
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• v.41 no.6
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• pp.359-366
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• 2007

Trigeminal neuralgia is a condition associated with severe episodic lancinating facial pain subject to remissions and relapses. Trigeminal neuralgia is often associated with blood vessel cross compression of the root entry zone or more rarely with demyelinating diseases and occasionally with direct compression by neoplasms of the posterior fossa. If initial medical management fails to control pain or is associated with unacceptable side effects, a variety of surgical procedures offer the hope for long-lasting pain relief or even cure. For patients who are healthy without significant medical co-morbidities, direct microsurgical vascular decompression [MVD] offers treatment that is often definitive. Other surgical options are effective for elderly patients not suitable for MVD. Percutaneous retrogasserian glycerol rhizotomy is a minimally invasive technique that is based on anatomic definition of the trigeminal cistern followed by injection of anhydrous glycerol to produce a weak neurolytic effect on the post-ganglionic fibers. Other percutaneous management strategies include radiofrequency rhizotomy and balloon compression. More recently, stereotactic radiosurgery has been used as a truly minimally invasive strategy. It also is anatomically based using high resolution MRI to define the retrogasserian target. Radiosurgery provides effective symptomatic relief in the vast majority of patients, especially those who have never had prior surgical procedures. For younger patients, we recommend microvascular decompression. For patients with severe exacerbations of their pain and who need rapid response to treatment, we suggest glycerol rhizotomy. For other patients, gamma knife radiosurgery represents an effective management strategy with excellent preservation of existing facial sensation.

• The Korean Journal of Pain
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• v.9 no.2
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• pp.407-411
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• 1996

Stereotactic radiofrequency dorsal root ganglionotomy can be very useful procedures for the treatment of pain emanating from the lumbar segmental nerves. This procedure is reserved for patients who have failed conservative interventional treatments and in whom open surgical intervention is not an option. The advantages of the radiofrequency lesion method are presented, excellent control of the lesion process using temperature monitoring to quantify the lesion size, prevent boiling, and to produce differential destruction of neural tissue. The afferent fibers in the ventral root which are spared by dorsal rhizotomy but nerve fibers with their cells in the ganglion from either dorsal or ventral root can be destructed with stereotactic radiofrequency ganglionotomy. This technique is performed using a 100 mm cannula with a 5 mm active tip. Repeated lateral fluoroscopic view should be taken to make sure that cannlua still resides within the superior, dorsal quadrant or the foramen. With the cannula in this position, electrostimulation is performed and good paresthesia on the leg should be noted with 0.3 and 0.5 volt at 50 Hz stimulation. At 2Hz stimulation distinct dissociation between motor and sensory should be shown. Percutaneous lumbar ganglionotomy have carried out under local anesthesia on inpatient basis in 6 patients. A series of 5 patients with metastatic cancer pain and a patient with compression fracture have been relieved of pain without serious complications.

• The Korean Journal of Pain
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• v.33 no.2
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• pp.183-191
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• 2020

Background: Opioids can present intolerable adverse side-effects to patients who use these analgesics to mitigate chronic pain. In this retrospective analysis, cooled radiofrequency (CRF) denervation was evaluated to provide pain and disability relief and reduce opioid use in patients with sacroiliac joint (SIJ) derived low back pain (LBP). Methods: Twenty-seven patients with pain from SIJ refractory to conservative treatments, and taking opioids chronically (> 3 mo), were included. Numeric rating scale (NRS) and Oswestry disability index (ODI) scores were collected at 1, 6, and 12 months post-procedure. Opioid use between baseline and each follow-up visit was compared for the entire group and for those who experienced successful (pain reduction ≥ 50% of baseline value) or unsuccessful CRF denervation. Results: Severe initial mean pain (NRS score: 7.7 ± 1.0) and disability (ODI score: 50.1 ± 9.0), and median opioid use (morphine equivalent daily dose: 40 ± 37 mg) were significantly reduced up to 12 months post-intervention. CRF denervation was successful in 44.4% of the patients at 12 months. Regardless of procedure success, patients demonstrated similar opioid reductions and changes in opioid use at 12 months. Two patients (7.4%) experienced neuritis following CRF denervation. Conclusions: CRF denervation of the SIJ can safely elicit pain and disability relief, and reduce opioid use, regardless of intervention success. Future studies may support CRF denervation as a dependable therapy to alleviate opioid use in patients with SIJ-derived LBP and show that opioid use measurements can be a surrogate indicator of pain.

• Journal of Korean Neurosurgical Society
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• v.59 no.6
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• pp.637-642
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• 2016

Objective : Although many treatment modalities have been introduced for trigeminal neuralgia (TN), the long-term clinical results remain unsatisfactory. It has been particularly challenging to determine an appropriate treatment strategy for patients who have responded poorly to initial therapies. We analyzed the surgical outcomes in TN patients who failed prior treatments. Methods : We performed a retrospective analysis of 37 patients with recurrent or persistent TN symptoms who underwent surgery at our hospital between January 2010 and December 2014. Patients with follow-up data of at least one year were included. The prior treatment modalities of the 37 patients included microvascular decompression (MVD), gamma knife radiosurgery (GKRS), and percutaneous procedures such as radiofrequency rhizotomy (RFR), balloon compression, and glycerol rhizotomy (GR). The mean follow-up period was 69.9 months (range : 16-173). The mean interval between the prior treatment and second surgery was 26 months (range : 7-123). We evaluated the surgical outcomes using the Barrow Neurological Institute (BNI) pain intensity scale. Results : Among the 37 recurrent or persistent TN patients, 22 underwent MVD with partial sensory rhizotomy (PSR), 8 received MVD alone, and 7 had PSR alone. Monitoring of the surgical treatment outcomes via the BNI pain intensity scale revealed 8 (21.6%) patients with a score of I, 13 (35.1%) scoring II, 13 (35.1%) scoring III, and 3 (8.2%) scoring IV at the end of the follow-up period. Overall, 91.8% of patients had good surgical outcomes. With regard to postoperative complications, 1 patient had transient cerebrospinal fluid rhinorrhea (2.7%), another had a subdural hematoma (2.7%), and facial sensory changes were noted in 8 (21.1%) patients after surgery. Conclusion : Surgical interventions, such as MVD and PSR, are safe and very effective treatment modalities in TN patients who failed initial or prior treatments. We presume that the combination of MVD with PSR enabled us to obtain good short- and long-term surgical outcomes. Therefore, aggressive surgical treatment should be considered in patients with recurrent TN despite failure of various treatment modalities.

• Journal of Korean Neurosurgical Society
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• v.65 no.5
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• pp.622-632
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• 2022

Microvascular decompression is the gold standard for the treatment of trigeminal neuralgia (TN). However, percutaneous techniques still play a role in treating patients with TN and offer several important advantages and efficiency in obtaining immediate pain relief, which is also durable in a less invasive and safe manner. Patients' preference for a less invasive method can influence the procedure they will undergo. Neurovascular conflict is not always a prerequisite for patients with TN. In addition, recurrence and failure of the previous procedure can influence the decision to follow the treatment. Therefore, indications for percutaneous procedures for TN persist when patients experience idiopathic and episodic sharp shooting pain. In this review, we provide an overview of percutaneous procedures for TN and its outcome and complication.