Postherpetic neuralgia (PHN) is a frequently occurring neuropathic pain, its pathophysiology is n... more Postherpetic neuralgia (PHN) is a frequently occurring neuropathic pain, its pathophysiology is not fully understood. There are only few evidence based therapeutic options; sympathetic nerve block can be considered for patients with PHN refractory to conservative treatment, but long-term effects are poor. Application of pulsed radiofrequency was effective to treat a variety of pain syndromes without neurological complications or other sequelae. Case Presentation: We observed a remarkable long-lasting pain relief in patients with post herpetic neuralgia (PHN) treated with caudal epidural PRF. We described the technique of caudal epidural PRF and three case reports. Conclusions: The mode of action of PRF is far from being completely elucidated. The high frequency current induces an electric field that in turn seems to influence the immunity, the inflammation and other pain conducting mechanisms. Our findings suggest an effect distal from the application of the current. It reaches targets that are difficultly attainable by any other means of current application. The observations of pain relief in the difficult to treat patients with PHN justifies further investigation.
Exhibit Hall Abs No 793 m OF INVESW: This study investigated magnetic resonance imaging (MRI) as ... more Exhibit Hall Abs No 793 m OF INVESW: This study investigated magnetic resonance imaging (MRI) as an imaging technique for directing stereotactic electrophysiologic exploration of the human thalamus. METHODS: Four patients underwent five "thalamotomies" for deep brain electrode mapping in chronic pain, Parkinson% and hemiballismus. Stereotactic coordinates were calculated using the Leksell frame with both MRI and CT. The coordinates calculated by the two methods were compared using the vector distance between the target points based on CT and MRI. The coordinates for anterior and posterior commissures were also compared using individual X. Y, and Z values. Paired t-test was employed. UULTS: MRI provided precise visualization of the regional anatomy of the thalamus and midbrain. Anterior and posterior commissures were easily identified with MRI. Multiplanar imaging produced direct sagittal images through the commissural line and coronal or axial images through either commissure. The coordinates calculated by CT and MRI were different (P.< 0.005). The range of discrepancy was l.lmm to 4.0mm. The range in an individual two dimensional plane was O.lmm to 4.0mm. The 3.0mm slice thickness with MRI contributes to this discrepancy. CONCLUSION: Stereotactic MRI offered better definition and less artifact of targets used for thalamotomy. There was discrepancy in comparison to CT. Further study is necessary to determine if this discrepancy is clinically significant in view of the fact that electrophysiologic data ultimately directs target choice. It is not determined at this point if MRI can stand alone for stereotactic thalamotomy.
The sphenopalatine (or pterygopalatine) ganglion (SPG) is mainly a parasympathetic ganglion in th... more The sphenopalatine (or pterygopalatine) ganglion (SPG) is mainly a parasympathetic ganglion in the upper part of the pterygopalatine fossa; its postsynaptic fibers supply the lacrimal, nasal, palatine, and pharyngeal glands. It is closely related to the maxillary nerve and lies just beneath the pterygopalatine (sphenopalatine) fossa (Fig. 11.1). The ganglion has a flat conical shape that can extend to a length of 5 mm. The fossa has a triangular shape with its basis at the floor of the sphenoid sinus with a length of approximately 2 and 1 cm width. On a lateral fluoroscopic view, the fossa resembles an “inverted vase” (Fig. 11.2). The fossa is bordered anteriorly by the posterior wall of the maxillary sinus, posteriorly by the pterygoid process and the ala major of the sphenoid bone, medially by the perpendicular plate of the palatine bone, and superiorly by the sphenoid sinus; laterally it communicates with the infratemporal fossa. The fossa is anteriorly connected to the orbit through the inferior orbital fissure, medially to the nasal cavity through the pterygo(spheno)palatine foramen, postero-superiorly to the middle skull “groove” through the foramen rotundum (which contains the maxillary nerve) and to the mouth through the palatine canal, and posteriorly to the nasopharynx. The fossa also contains the maxillary artery and its multiple branches.
Das Ganglion sphenopalatinum (GSP) ist ein autonomes Ganglion, das neben autonomen efferenten auc... more Das Ganglion sphenopalatinum (GSP) ist ein autonomes Ganglion, das neben autonomen efferenten auch afferente Nervenfasern umfasst. Das GSP ist ein Teil des trigeminovaskularen Systems und ist wahrscheinlich bei verschiedenen Formen vaskularer Kopfschmerzen und atypischer Gesichtsschmerzen beteiligt [6]. Das GSP liegt tief in der Fossa pterygopalatina. Dieser pyramidenformige Raum wird an der Hinterseite durch den Processus pterygoideus und die Ala major des Os sphenoidale begrenzt, an der medialen Seite durch die Lamina perpendicularis des Os palatinum und an der Vorderseite durch die Maxilla. Lateral steht die Fossa mit der Fossa infratemporalis durch die Fissura pterygomaxillaris in Verbindung. Die Fossa pterygopalatina ist im ubrigen in Kontakt mit der Nasenhohle durch das Foramen sphenopalatinum (medial), mit der Orbita durch die Fissura orbitalis inferior (anterior), mit dem mittleren Schadelschacht durch das Foramen rotundum (posterosuperior) und mit der Mundhohle durch den Canalis palatinus major (inferior). Zum Schluss mundet sie an der Hinterseite des Canalis pterygoideus und verlauft inframedial als Canalis palatinovaginalis zum Nasopharynx (Abb. 1; [27]).
Discogenic pain is an important cause of low back pain (LBP). We have developed a pulsed radiofre... more Discogenic pain is an important cause of low back pain (LBP). We have developed a pulsed radiofrequency (P-RF) technique, using two electrodes placed bilaterally in the annulus, for applying radiofrequency current in the disc (bi-annular P-RF disc method). The purpose of this study was to investigate the effect of the bi-annular P-RF disc method, using Diskit needles (Neurotherm, Middleton, MA, USA) in patients with discogenic LBP. The subjects were 15 patients with a mean age of 37.3 ± 8.63 years with chronic discogenic lower back pain that was not responsive to aggressive nonoperative care. Two Diskit II needles (15-cm length, 20G needles with a 20-mm active tip) were placed bilaterally in the annulus in the disc. Pulsed radiofrequency was applied for 12 min at a setting of 5 × 50 ms/s and 60 V. The pain intensity scores on a 0-10 numeric rating scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ) were measured pretreatment, and at 1 week and 1, 3, and 6 months post-treatment. The mean pain severity score (NRS) improved from 7.27 ± 0.58 pretreatment to 2.5 ± 0.94 at the 6-month follow-up (p &lt; 0.01). The RMDQ showed significant (p &lt; 0.01) improvement, from 10.70 ± 2.35 pretreatment to 2.10 ± 1.85 at the 6-month follow up (p &lt; 0.01). The bi-annular P-RF disc method with consecutive P-RF 5/5/60 V, 12-min (with Diskit needle), appears to be a safe, minimally invasive treatment option for patients with chronic discogenic LBP.
Regional Nerve Blocks in Anesthesia and Pain Therapy, 2015
Zygapophyseal or facet joints are formed by the inferior and superior processes of two adjacent j... more Zygapophyseal or facet joints are formed by the inferior and superior processes of two adjacent joints. These joints limit excessive mobility and distribute the axial loading over a broad area. The facet joints located at the dorsal side of the spine together with the intervertebral disc at the ventral side form the three moving parts of the motion segment. Compared to the lumbar facet joints, the cervical facet joints are relatively big joints. The facet joints are innervated by the medial branch of the dorsal ramus of the spinal nerve.
Regional Nerve Blocks in Anesthesia and Pain Therapy, 2015
The sphenopalatine (or pterygopalatine) ganglion (SPG) is mainly a parasympathetic ganglion in th... more The sphenopalatine (or pterygopalatine) ganglion (SPG) is mainly a parasympathetic ganglion in the upper part of the pterygopalatine fossa; its postsynaptic fibers supply the lacrimal, nasal, palatine, and pharyngeal glands. It is closely related to the maxillary nerve and lies just beneath the pterygopalatine (sphenopalatine) fossa (Fig. 11.1). The ganglion has a flat conical shape that can extend to a length of 5 mm. The fossa has a triangular shape with its basis at the floor of the sphenoid sinus with a length of approximately 2 and 1 cm width. On a lateral fluoroscopic view, the fossa resembles an “inverted vase” (Fig. 11.2). The fossa is bordered anteriorly by the posterior wall of the maxillary sinus, posteriorly by the pterygoid process and the ala major of the sphenoid bone, medially by the perpendicular plate of the palatine bone, and superiorly by the sphenoid sinus; laterally it communicates with the infratemporal fossa. The fossa is anteriorly connected to the orbit through the inferior orbital fissure, medially to the nasal cavity through the pterygo(spheno)palatine foramen, postero-superiorly to the middle skull “groove” through the foramen rotundum (which contains the maxillary nerve) and to the mouth through the palatine canal, and posteriorly to the nasopharynx. The fossa also contains the maxillary artery and its multiple branches.
Neurodestruktive Verfahren in der Schmerztherapie, 1998
Das Ganglion sphenopalatinum (GSP) ist ein autonomes Ganglion, das neben autonomen efferenten auc... more Das Ganglion sphenopalatinum (GSP) ist ein autonomes Ganglion, das neben autonomen efferenten auch afferente Nervenfasern umfasst. Das GSP ist ein Teil des trigeminovaskularen Systems und ist wahrscheinlich bei verschiedenen Formen vaskularer Kopfschmerzen und atypischer Gesichtsschmerzen beteiligt [6]. Das GSP liegt tief in der Fossa pterygopalatina. Dieser pyramidenformige Raum wird an der Hinterseite durch den Processus pterygoideus und die Ala major des Os sphenoidale begrenzt, an der medialen Seite durch die Lamina perpendicularis des Os palatinum und an der Vorderseite durch die Maxilla. Lateral steht die Fossa mit der Fossa infratemporalis durch die Fissura pterygomaxillaris in Verbindung. Die Fossa pterygopalatina ist im ubrigen in Kontakt mit der Nasenhohle durch das Foramen sphenopalatinum (medial), mit der Orbita durch die Fissura orbitalis inferior (anterior), mit dem mittleren Schadelschacht durch das Foramen rotundum (posterosuperior) und mit der Mundhohle durch den Canalis palatinus major (inferior). Zum Schluss mundet sie an der Hinterseite des Canalis pterygoideus und verlauft inframedial als Canalis palatinovaginalis zum Nasopharynx (Abb. 1; [27]).
Exhibit Hall Abs No 793 m OF INVESW: This study investigated magnetic resonance imaging (MRI) as ... more Exhibit Hall Abs No 793 m OF INVESW: This study investigated magnetic resonance imaging (MRI) as an imaging technique for directing stereotactic electrophysiologic exploration of the human thalamus. METHODS: Four patients underwent five "thalamotomies" for deep brain electrode mapping in chronic pain, Parkinson% and hemiballismus. Stereotactic coordinates were calculated using the Leksell frame with both MRI and CT. The coordinates calculated by the two methods were compared using the vector distance between the target points based on CT and MRI. The coordinates for anterior and posterior commissures were also compared using individual X. Y, and Z values. Paired t-test was employed. UULTS: MRI provided precise visualization of the regional anatomy of the thalamus and midbrain. Anterior and posterior commissures were easily identified with MRI. Multiplanar imaging produced direct sagittal images through the commissural line and coronal or axial images through either commissure. The coordinates calculated by CT and MRI were different (P.< 0.005). The range of discrepancy was l.lmm to 4.0mm. The range in an individual two dimensional plane was O.lmm to 4.0mm. The 3.0mm slice thickness with MRI contributes to this discrepancy. CONCLUSION: Stereotactic MRI offered better definition and less artifact of targets used for thalamotomy. There was discrepancy in comparison to CT. Further study is necessary to determine if this discrepancy is clinically significant in view of the fact that electrophysiologic data ultimately directs target choice. It is not determined at this point if MRI can stand alone for stereotactic thalamotomy.
Discogenic pain is an important cause of low back pain (LBP). We have developed a pulsed radiofre... more Discogenic pain is an important cause of low back pain (LBP). We have developed a pulsed radiofrequency (P-RF) technique, using two electrodes placed bilaterally in the annulus, for applying radiofrequency current in the disc (bi-annular P-RF disc method). The purpose of this study was to investigate the effect of the bi-annular P-RF disc method, using Diskit needles (Neurotherm, Middleton, MA, USA) in patients with discogenic LBP. The subjects were 15 patients with a mean age of 37.3 ± 8.63 years with chronic discogenic lower back pain that was not responsive to aggressive nonoperative care. Two Diskit II needles (15-cm length, 20G needles with a 20-mm active tip) were placed bilaterally in the annulus in the disc. Pulsed radiofrequency was applied for 12 min at a setting of 5 × 50 ms/s and 60 V. The pain intensity scores on a 0-10 numeric rating scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ) were measured pretreatment, and at 1 week and 1, 3, and 6 months post-treatment. The mean pain severity score (NRS) improved from 7.27 ± 0.58 pretreatment to 2.5 ± 0.94 at the 6-month follow-up (p &lt; 0.01). The RMDQ showed significant (p &lt; 0.01) improvement, from 10.70 ± 2.35 pretreatment to 2.10 ± 1.85 at the 6-month follow up (p &lt; 0.01). The bi-annular P-RF disc method with consecutive P-RF 5/5/60 V, 12-min (with Diskit needle), appears to be a safe, minimally invasive treatment option for patients with chronic discogenic LBP.
The development of diagnostic criteria and the use of provocative discography allow identifying t... more The development of diagnostic criteria and the use of provocative discography allow identifying the degenerative disc as causative structure for chronic lowback pain. Unfortunately, none of the available interventional treatment options have been demonstrated to be effective over a prolonged period of time for a considerable number of patients. Pathophysiological studies indicate sprouting of sensory nerves and inflammatory processes as underlying pain mechanisms. Pulsed radiofrequency (PRF) treatment in small and larger joints was described to reduce pain and improve healing by stimulating the immunology. Earlier findings of PRF applied in the disc annulus were promising. It is assumed that PRF applied in the nucleus would change the conductivity of nerve endings and provide a clinically relevant pain reduction. The application of the electric field of PRF in the disc may also activate the immune system, thus reducing the inflammation process of chronic pain. Pulsed radiofrequency in the nucleus was studied in 76 patients with discogenic pain confirmed by magnetic resonance imaging and provocative discography. At 3-month follow-up, 38% of the patients had > 50% pain reduction, at 12 month the effect is maintained in 29%. In patients with unsatisfactory pain relief 3 months after the intervention, secondary pain sources may have been revealed. The latter were treated accordingly. Of all patients, 56% had > 50% pain reduction 1 year after first treatment. Our findings suggest that PRF in the nucleus may be considered for patients with proven discogenic pain. A randomized controlled trial to confirm our findings is justified. n
Postherpetic neuralgia (PHN) is a frequently occurring neuropathic pain, its pathophysiology is n... more Postherpetic neuralgia (PHN) is a frequently occurring neuropathic pain, its pathophysiology is not fully understood. There are only few evidence based therapeutic options; sympathetic nerve block can be considered for patients with PHN refractory to conservative treatment, but long-term effects are poor. Application of pulsed radiofrequency was effective to treat a variety of pain syndromes without neurological complications or other sequelae. Case Presentation: We observed a remarkable long-lasting pain relief in patients with post herpetic neuralgia (PHN) treated with caudal epidural PRF. We described the technique of caudal epidural PRF and three case reports. Conclusions: The mode of action of PRF is far from being completely elucidated. The high frequency current induces an electric field that in turn seems to influence the immunity, the inflammation and other pain conducting mechanisms. Our findings suggest an effect distal from the application of the current. It reaches targets that are difficultly attainable by any other means of current application. The observations of pain relief in the difficult to treat patients with PHN justifies further investigation.
Exhibit Hall Abs No 793 m OF INVESW: This study investigated magnetic resonance imaging (MRI) as ... more Exhibit Hall Abs No 793 m OF INVESW: This study investigated magnetic resonance imaging (MRI) as an imaging technique for directing stereotactic electrophysiologic exploration of the human thalamus. METHODS: Four patients underwent five "thalamotomies" for deep brain electrode mapping in chronic pain, Parkinson% and hemiballismus. Stereotactic coordinates were calculated using the Leksell frame with both MRI and CT. The coordinates calculated by the two methods were compared using the vector distance between the target points based on CT and MRI. The coordinates for anterior and posterior commissures were also compared using individual X. Y, and Z values. Paired t-test was employed. UULTS: MRI provided precise visualization of the regional anatomy of the thalamus and midbrain. Anterior and posterior commissures were easily identified with MRI. Multiplanar imaging produced direct sagittal images through the commissural line and coronal or axial images through either commissure. The coordinates calculated by CT and MRI were different (P.< 0.005). The range of discrepancy was l.lmm to 4.0mm. The range in an individual two dimensional plane was O.lmm to 4.0mm. The 3.0mm slice thickness with MRI contributes to this discrepancy. CONCLUSION: Stereotactic MRI offered better definition and less artifact of targets used for thalamotomy. There was discrepancy in comparison to CT. Further study is necessary to determine if this discrepancy is clinically significant in view of the fact that electrophysiologic data ultimately directs target choice. It is not determined at this point if MRI can stand alone for stereotactic thalamotomy.
The sphenopalatine (or pterygopalatine) ganglion (SPG) is mainly a parasympathetic ganglion in th... more The sphenopalatine (or pterygopalatine) ganglion (SPG) is mainly a parasympathetic ganglion in the upper part of the pterygopalatine fossa; its postsynaptic fibers supply the lacrimal, nasal, palatine, and pharyngeal glands. It is closely related to the maxillary nerve and lies just beneath the pterygopalatine (sphenopalatine) fossa (Fig. 11.1). The ganglion has a flat conical shape that can extend to a length of 5 mm. The fossa has a triangular shape with its basis at the floor of the sphenoid sinus with a length of approximately 2 and 1 cm width. On a lateral fluoroscopic view, the fossa resembles an “inverted vase” (Fig. 11.2). The fossa is bordered anteriorly by the posterior wall of the maxillary sinus, posteriorly by the pterygoid process and the ala major of the sphenoid bone, medially by the perpendicular plate of the palatine bone, and superiorly by the sphenoid sinus; laterally it communicates with the infratemporal fossa. The fossa is anteriorly connected to the orbit through the inferior orbital fissure, medially to the nasal cavity through the pterygo(spheno)palatine foramen, postero-superiorly to the middle skull “groove” through the foramen rotundum (which contains the maxillary nerve) and to the mouth through the palatine canal, and posteriorly to the nasopharynx. The fossa also contains the maxillary artery and its multiple branches.
Das Ganglion sphenopalatinum (GSP) ist ein autonomes Ganglion, das neben autonomen efferenten auc... more Das Ganglion sphenopalatinum (GSP) ist ein autonomes Ganglion, das neben autonomen efferenten auch afferente Nervenfasern umfasst. Das GSP ist ein Teil des trigeminovaskularen Systems und ist wahrscheinlich bei verschiedenen Formen vaskularer Kopfschmerzen und atypischer Gesichtsschmerzen beteiligt [6]. Das GSP liegt tief in der Fossa pterygopalatina. Dieser pyramidenformige Raum wird an der Hinterseite durch den Processus pterygoideus und die Ala major des Os sphenoidale begrenzt, an der medialen Seite durch die Lamina perpendicularis des Os palatinum und an der Vorderseite durch die Maxilla. Lateral steht die Fossa mit der Fossa infratemporalis durch die Fissura pterygomaxillaris in Verbindung. Die Fossa pterygopalatina ist im ubrigen in Kontakt mit der Nasenhohle durch das Foramen sphenopalatinum (medial), mit der Orbita durch die Fissura orbitalis inferior (anterior), mit dem mittleren Schadelschacht durch das Foramen rotundum (posterosuperior) und mit der Mundhohle durch den Canalis palatinus major (inferior). Zum Schluss mundet sie an der Hinterseite des Canalis pterygoideus und verlauft inframedial als Canalis palatinovaginalis zum Nasopharynx (Abb. 1; [27]).
Discogenic pain is an important cause of low back pain (LBP). We have developed a pulsed radiofre... more Discogenic pain is an important cause of low back pain (LBP). We have developed a pulsed radiofrequency (P-RF) technique, using two electrodes placed bilaterally in the annulus, for applying radiofrequency current in the disc (bi-annular P-RF disc method). The purpose of this study was to investigate the effect of the bi-annular P-RF disc method, using Diskit needles (Neurotherm, Middleton, MA, USA) in patients with discogenic LBP. The subjects were 15 patients with a mean age of 37.3 ± 8.63 years with chronic discogenic lower back pain that was not responsive to aggressive nonoperative care. Two Diskit II needles (15-cm length, 20G needles with a 20-mm active tip) were placed bilaterally in the annulus in the disc. Pulsed radiofrequency was applied for 12 min at a setting of 5 × 50 ms/s and 60 V. The pain intensity scores on a 0-10 numeric rating scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ) were measured pretreatment, and at 1 week and 1, 3, and 6 months post-treatment. The mean pain severity score (NRS) improved from 7.27 ± 0.58 pretreatment to 2.5 ± 0.94 at the 6-month follow-up (p &lt; 0.01). The RMDQ showed significant (p &lt; 0.01) improvement, from 10.70 ± 2.35 pretreatment to 2.10 ± 1.85 at the 6-month follow up (p &lt; 0.01). The bi-annular P-RF disc method with consecutive P-RF 5/5/60 V, 12-min (with Diskit needle), appears to be a safe, minimally invasive treatment option for patients with chronic discogenic LBP.
Regional Nerve Blocks in Anesthesia and Pain Therapy, 2015
Zygapophyseal or facet joints are formed by the inferior and superior processes of two adjacent j... more Zygapophyseal or facet joints are formed by the inferior and superior processes of two adjacent joints. These joints limit excessive mobility and distribute the axial loading over a broad area. The facet joints located at the dorsal side of the spine together with the intervertebral disc at the ventral side form the three moving parts of the motion segment. Compared to the lumbar facet joints, the cervical facet joints are relatively big joints. The facet joints are innervated by the medial branch of the dorsal ramus of the spinal nerve.
Regional Nerve Blocks in Anesthesia and Pain Therapy, 2015
The sphenopalatine (or pterygopalatine) ganglion (SPG) is mainly a parasympathetic ganglion in th... more The sphenopalatine (or pterygopalatine) ganglion (SPG) is mainly a parasympathetic ganglion in the upper part of the pterygopalatine fossa; its postsynaptic fibers supply the lacrimal, nasal, palatine, and pharyngeal glands. It is closely related to the maxillary nerve and lies just beneath the pterygopalatine (sphenopalatine) fossa (Fig. 11.1). The ganglion has a flat conical shape that can extend to a length of 5 mm. The fossa has a triangular shape with its basis at the floor of the sphenoid sinus with a length of approximately 2 and 1 cm width. On a lateral fluoroscopic view, the fossa resembles an “inverted vase” (Fig. 11.2). The fossa is bordered anteriorly by the posterior wall of the maxillary sinus, posteriorly by the pterygoid process and the ala major of the sphenoid bone, medially by the perpendicular plate of the palatine bone, and superiorly by the sphenoid sinus; laterally it communicates with the infratemporal fossa. The fossa is anteriorly connected to the orbit through the inferior orbital fissure, medially to the nasal cavity through the pterygo(spheno)palatine foramen, postero-superiorly to the middle skull “groove” through the foramen rotundum (which contains the maxillary nerve) and to the mouth through the palatine canal, and posteriorly to the nasopharynx. The fossa also contains the maxillary artery and its multiple branches.
Neurodestruktive Verfahren in der Schmerztherapie, 1998
Das Ganglion sphenopalatinum (GSP) ist ein autonomes Ganglion, das neben autonomen efferenten auc... more Das Ganglion sphenopalatinum (GSP) ist ein autonomes Ganglion, das neben autonomen efferenten auch afferente Nervenfasern umfasst. Das GSP ist ein Teil des trigeminovaskularen Systems und ist wahrscheinlich bei verschiedenen Formen vaskularer Kopfschmerzen und atypischer Gesichtsschmerzen beteiligt [6]. Das GSP liegt tief in der Fossa pterygopalatina. Dieser pyramidenformige Raum wird an der Hinterseite durch den Processus pterygoideus und die Ala major des Os sphenoidale begrenzt, an der medialen Seite durch die Lamina perpendicularis des Os palatinum und an der Vorderseite durch die Maxilla. Lateral steht die Fossa mit der Fossa infratemporalis durch die Fissura pterygomaxillaris in Verbindung. Die Fossa pterygopalatina ist im ubrigen in Kontakt mit der Nasenhohle durch das Foramen sphenopalatinum (medial), mit der Orbita durch die Fissura orbitalis inferior (anterior), mit dem mittleren Schadelschacht durch das Foramen rotundum (posterosuperior) und mit der Mundhohle durch den Canalis palatinus major (inferior). Zum Schluss mundet sie an der Hinterseite des Canalis pterygoideus und verlauft inframedial als Canalis palatinovaginalis zum Nasopharynx (Abb. 1; [27]).
Exhibit Hall Abs No 793 m OF INVESW: This study investigated magnetic resonance imaging (MRI) as ... more Exhibit Hall Abs No 793 m OF INVESW: This study investigated magnetic resonance imaging (MRI) as an imaging technique for directing stereotactic electrophysiologic exploration of the human thalamus. METHODS: Four patients underwent five "thalamotomies" for deep brain electrode mapping in chronic pain, Parkinson% and hemiballismus. Stereotactic coordinates were calculated using the Leksell frame with both MRI and CT. The coordinates calculated by the two methods were compared using the vector distance between the target points based on CT and MRI. The coordinates for anterior and posterior commissures were also compared using individual X. Y, and Z values. Paired t-test was employed. UULTS: MRI provided precise visualization of the regional anatomy of the thalamus and midbrain. Anterior and posterior commissures were easily identified with MRI. Multiplanar imaging produced direct sagittal images through the commissural line and coronal or axial images through either commissure. The coordinates calculated by CT and MRI were different (P.< 0.005). The range of discrepancy was l.lmm to 4.0mm. The range in an individual two dimensional plane was O.lmm to 4.0mm. The 3.0mm slice thickness with MRI contributes to this discrepancy. CONCLUSION: Stereotactic MRI offered better definition and less artifact of targets used for thalamotomy. There was discrepancy in comparison to CT. Further study is necessary to determine if this discrepancy is clinically significant in view of the fact that electrophysiologic data ultimately directs target choice. It is not determined at this point if MRI can stand alone for stereotactic thalamotomy.
Discogenic pain is an important cause of low back pain (LBP). We have developed a pulsed radiofre... more Discogenic pain is an important cause of low back pain (LBP). We have developed a pulsed radiofrequency (P-RF) technique, using two electrodes placed bilaterally in the annulus, for applying radiofrequency current in the disc (bi-annular P-RF disc method). The purpose of this study was to investigate the effect of the bi-annular P-RF disc method, using Diskit needles (Neurotherm, Middleton, MA, USA) in patients with discogenic LBP. The subjects were 15 patients with a mean age of 37.3 ± 8.63 years with chronic discogenic lower back pain that was not responsive to aggressive nonoperative care. Two Diskit II needles (15-cm length, 20G needles with a 20-mm active tip) were placed bilaterally in the annulus in the disc. Pulsed radiofrequency was applied for 12 min at a setting of 5 × 50 ms/s and 60 V. The pain intensity scores on a 0-10 numeric rating scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ) were measured pretreatment, and at 1 week and 1, 3, and 6 months post-treatment. The mean pain severity score (NRS) improved from 7.27 ± 0.58 pretreatment to 2.5 ± 0.94 at the 6-month follow-up (p &lt; 0.01). The RMDQ showed significant (p &lt; 0.01) improvement, from 10.70 ± 2.35 pretreatment to 2.10 ± 1.85 at the 6-month follow up (p &lt; 0.01). The bi-annular P-RF disc method with consecutive P-RF 5/5/60 V, 12-min (with Diskit needle), appears to be a safe, minimally invasive treatment option for patients with chronic discogenic LBP.
The development of diagnostic criteria and the use of provocative discography allow identifying t... more The development of diagnostic criteria and the use of provocative discography allow identifying the degenerative disc as causative structure for chronic lowback pain. Unfortunately, none of the available interventional treatment options have been demonstrated to be effective over a prolonged period of time for a considerable number of patients. Pathophysiological studies indicate sprouting of sensory nerves and inflammatory processes as underlying pain mechanisms. Pulsed radiofrequency (PRF) treatment in small and larger joints was described to reduce pain and improve healing by stimulating the immunology. Earlier findings of PRF applied in the disc annulus were promising. It is assumed that PRF applied in the nucleus would change the conductivity of nerve endings and provide a clinically relevant pain reduction. The application of the electric field of PRF in the disc may also activate the immune system, thus reducing the inflammation process of chronic pain. Pulsed radiofrequency in the nucleus was studied in 76 patients with discogenic pain confirmed by magnetic resonance imaging and provocative discography. At 3-month follow-up, 38% of the patients had > 50% pain reduction, at 12 month the effect is maintained in 29%. In patients with unsatisfactory pain relief 3 months after the intervention, secondary pain sources may have been revealed. The latter were treated accordingly. Of all patients, 56% had > 50% pain reduction 1 year after first treatment. Our findings suggest that PRF in the nucleus may be considered for patients with proven discogenic pain. A randomized controlled trial to confirm our findings is justified. n
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