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UNASSIGNED: Percutaneous rhizotomy is a group of techniques used to treat trigeminal neuralgia. Radiofrequency thermocoagulation (RF) and Chemical Rhizotomy (CR) using glycerol are among the most frequently used methods. We have recently refined Ethanol Rhizotomy (ER) under Digital Subtraction Angiography (DSA) guidance.
UNASSIGNED: A descriptive, retrospective study was conducted to compare our refined ER and RF ablation in patients with trigeminal neuralgia in terms of long-term pain relief and side effects.
UNASSIGNED: Between 2012 and 2014, 33 patients with typical trigeminal neuralgia were enrolled, 10 of whom received RF and 23 received ER under (DSA) guidance with ethanol injected while in the supine position. The pain relief, duration of pain-free period, need for repeat injection, and recurrence of pain were recorded together with procedure-related complications within 7 years after the procedures.
UNASSIGNED: After a single intervention or, in some cases, a maximum of two repeated interventions, all 33 patients experienced complete pain relief. Nevertheless, following a single procedure, the success rate was 95.6% (22/23) in the ER group and 60% (6/10) in the RF group. Notably, complete numbness was the most significant side effect, with a higher incidence in the ER group (30.4%) compared to the RF group (0%) (p = 0.02). The recurrence rate was statistically different (p = 0.01) between the two groups, with 4.4% and 40% recorded in the ER and RF groups, respectively.
UNASSIGNED: We demonstrated the usefulness of our refined ER procedure as a safe, cost-effective, and efficient second-line treatment for TN.

To explore experiences, expectations, and involvement of children and young people (CYP) in decision-making for selective dorsal rhizotomy (SDR) surgery, post-operative physiotherapy treatment and outcomes.
A qualitative study design using one to one interviews. Five CYP (2 girls and 3 boys) participated, and interviews lasted between 45 min and 2 h. Data were analyzed using thematic analysis.
Children and young people are reliant on their parents to make decisions and inform them of the SDR process. Experiences of living with cerebral palsy and its management are centered on their routine social, psychological, and physiological challenges. Individual characteristics and attributes of CYP have an impact on how they cope with the rehabilitation burden and adjust to their changing levels of function and participation.
Although CYP reported that SDR offers them a greater \'freedom to choose\' in how they participate in daily life, further consideration is required to meet their psychosocial needs, particularly in preparing for SDR and adjusting afterwards.

BACKGROUND: Selective posterior rhizotomy (SPR) is a preferred procedure for relieving spastic children with cerebral palsy, but it is associated with severe pain and significant emergence agitation (EA). The thoracolumbar interfascial plane (TLIP) block provides an effective blockade to the dorsal branch of the spinal nerve. We hypothesise that the TLIP block may be an effective tool to alleviate EA and postoperative pain scores in children with cerebral palsy undergoing SPR.
METHODS: This study is a single-centre, randomised, parallel-controlled trial being conducted in Beijing, China. A total of 50 paediatric patients with cerebral palsy scheduled for SPR are randomised in a 1:1 ratio to receive bilateral TLIP block with 0.2% ropivacaine 0.5 mL/kg or control. Patients in the TLIP group receive general anaesthesia combined with TLIP block, while patients in the control group receive only general anaesthesia, without a TLIP block. The primary outcome is the Paediatric Anaesthesia Emergence Delirium Score. The secondary outcomes are the incidence of EA, the Wong-Baker Faces Pain-rating Scale, the perioperative haemodynamics, the intraoperative remifentanil and propofol dosage, the extubation time and recovery time, and adverse reactions.
BACKGROUND: This study was approved by the Ethics Committee of Dongzhimen Hospital, Beijing University of Chinese Medicine on 21 September 2023 (2023DZMEC-379-02). Written informed consent is obtained from the legal guardian of each patient. The results of this study will be published in peer-reviewed international journals.
BACKGROUND: ChiCTR2300076397.

OBJECTIVE: Patients undergoing percutaneous rhizotomy for trigeminal neuralgia (TN) may require several procedures to manage their pain. However, it is not fully understood whether repeat procedures influence postoperative complication rates.
METHODS: We retrospectively reviewed patients undergoing rhizotomy at our institution from 2011 to 2022. Patients were included only if they had no history of prior interventions including microvascular decompression (MVD) or radiosurgery. We collected baseline patient information, pain characteristics, and postoperative complications for each patient. Patients were dichotomized into those undergoing primary rhizotomy versus those undergoing a repeat rhizotomy. Potential drivers of postoperative complications were included in a multivariate logistic regression model.
RESULTS: Of the 1904 cases reviewed, 965 met our inclusion criteria. 392 patients underwent primary rhizotomy, and 573 patients underwent repeat rhizotomies. The repeat rhizotomy group was significantly older, p<0.001. Patients in the repeat rhizotomy group expressed higher frequencies of bilateral pain, p=0.01. Patients in the repeat rhizotomy group demonstrated a significantly higher rate of preoperative numbness and postoperative numbness, p<0.001. There were no significant differences in any of the considered complications between the single rhizotomy and repeat rhizotomy groups. On multivariate logistic regression, repeat rhizotomy did not predict an increased risk of any postoperative complications, p=0.14.
CONCLUSIONS: Patients undergoing repeat rhizotomy may be at risk of postoperative numbness but are not at increased risk for postoperative complications. These results are of use to patients who are poor surgical candidates, and thus may require multiple rhizotomies to effectively manage their pain over time.

UNASSIGNED: Equine trigeminal-mediated headshaking is a painful neuropathic disorder comparable to trigeminal neuralgia in humans. The selective destruction of pain fibers within the trigeminal ganglion, called rhizotomy, is the surgical treatment of choice for idiopathic trigeminal neuralgia refractory to medical treatment in humans. The human trigeminal ganglion is enclosed by a dural recess called the Meckel\'s or trigeminal cave, in which the ganglion is surrounded by a cerebrospinal fluid (CSF)-filled subarachnoid space. During glycerol rhizotomy, glycerol is percutaneously injected in this CSF-filled space. Until now, information about the anatomy of the dural recess and the subarachnoid space surrounding the trigeminal ganglion is lacking in horses. The aim of this study was to explore if a CSF-filled subarachnoid space around the trigeminal ganglion exists in horses.
UNASSIGNED: Six equine cadaver heads were investigated for CSF accumulation around the ganglion with a 3 Tesla MRI. After anatomical dissection to expose the trigeminal root, a polymer-based radiopaque contrast agent was injected through the porus trigeminus into the subarachnoid space (cisternography). The exact delineation and the volume of the contrast agent accumulation were determined on subsequent micro-computed tomographic scans and segmentation. Finally, the distribution of the contrast agent within the subarachnoid space was examined histologically in three specimens.
UNASSIGNED: In all 12 specimens included in this study, the trigeminal ganglion was surrounded by a subarachnoid space forming a trigeminal cistern. The mean volume of the trigeminal cave in this study was 0.31 mL (±SD: 0.11 mL). Distribution of the contrast agent along the peripheral nerves (i.e., ophthalmic, maxillary and/or mandibular nerve) was observed in 7 out of 12 specimens.
UNASSIGNED: A subarachnoid space surrounding the trigeminal ganglion exists in the horse and could be targeted for glycerol rhizotomy in horses suffering from trigeminal-mediated headshaking. However, the clinical relevance of contrast agent distribution along the peripheral nerves remains to be assessed.

BACKGROUND: Surgical selective dorsal rhizotomy (SDR) in appropriate pediatric cerebral palsy patients is an effective treatment for spasticity. However, there remains heterogeneity reported in postoperative pain management with and without opioid medication in this delicate cohort. The objective of this study was to aggregate pertinent metadata by means of systematic review to summarize all relevant postoperative pain regimens in the literature.
METHODS: Searches of multiple electronic databases from inception to June 2024 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. Outcomes and regimens were then summarized.
RESULTS: A total of 16 cohort studies were included in this study published between 1989 and 2024. Amongst all studies, outcomes were reported for a total of 636 with median cohort age 6.3 years, and median cohort male proportion 62% was reported. Four studies reported regimens involving systemic analgesia, 8 studies reported regimens involving epidural analgesia, and the remaining 4 studies reported regimens involving intrathecal analgesia. All studies primary pain management involved opioid medication, with 8 studies having opioid medication available as indicated, 3 studies having opioid medication as a single dose, and the remaining studies having opioid medication as a continuous agent in the immediate postoperative period. Across all studies, rates of desaturations, nausea and/or vomiting, and pruritis ranged from 0 to 55%, 25 to 82%, and 15 to 70% respectively. Eleven of the 16 studies included a comparative component, demonstrating that their regimen was at least comparable to their control regimen, if not superior.
CONCLUSIONS: Multiple variations of postoperative pain management in pediatric cerebral palsy patients following SDR have been reported in the literature, involving systemic, epidural, and intrathecal analgesia. Concerns for adverse effects with the utilization of opioid medication has led to the trend towards multimodal pain management relying more on non-opioid medication regimens in the more recent literature.

BACKGROUND: Cerebral palsy (CP) is the most cause of motor dysfunction in children. Selective dorsal rhizotomy (SDR) plays a major role in long term spasticity control. However, limited data exists on the effect of SDR on postoperative spasticity treatment requirements and supraspinal effects, and the stimulation responses of dorsal nerve roots in those with CP.
METHODS: The current study included the outcome for 35 individuals undergoing SDR for motor functional outcome, spasticity, baclofen dose changes, botulinum toxin injection frequency, and spasticity related orthopedic procedures. We also report on the stimulation responses in 112 individuals who underwent SDR at our institution.
RESULTS: There was a significant difference in gross motor function measures (GMFM)-66 scores at last follow up that remained present when considering only ambulatory children but not with non-ambulatory children. Ashworth scores were significantly decreased for both upper and lower extremities after SDR at all follow up points. There was a significant decrease in Baclofen dose and botulinum toxin injections requirements after SDR, but no significant difference in the need for orthopedic intervention. A total of 5502 dorsal nerve roots were tested showing a decrease in stimulation intensity and increase in grade on the right side and for descending lumbosacral levels.
CONCLUSIONS: SDR improves gross motor scores during short term follow up but has additional benefits in decreasing baclofen dosing and botulinum toxin injections requirements after surgery. They stimulation responses of sectioned dorsal nerve roots adds to the limited available data and our understanding of the pathological changes that occur in CP.

OBJECTIVE: Selective dorsal rhizotomy (SDR) is a neurosurgical intervention used to reduce spasticity in children with cerebral palsy (CP). There is minimal relevant, evidence-based information available for Australian families and clinicians. This study aims to investigate the knowledge of people with lived experience and clinicians regarding SDR, including how they currently access information and what information they seek.
METHODS: Adults with CP, carers of children with CP and clinicians treating children with CP were invited to complete an online survey. Data regarding participant demographics, current knowledge and confidence in knowledge about CP and SDR, information source/s used and participants level of trust in these sources are presented as counts and percentages. Comparisons in knowledge between groups were analysed.
RESULTS: A total of 114 surveys were completed: 63 clinicians, 48 carers, and 3 adults with CP. Eighty percent of clinicians were allied health professionals. People with lived experience were less confident in their knowledge about SDR compared to knowledge of CP (P < 0.001). Clinicians rated scientific research literature and the hospital team as the most useful and trustworthy information source. People with lived experience used a wider range of information sources including the internet, rating their community therapy team and other people with lived experience as the most useful.
CONCLUSIONS: This study identified a lack of confidence in knowledge of SDR for people with lived experience, likely due to a gap in accessible and readable evidence-based information. While both groups differed in how they access information, there was agreement that greater information about SDR is needed.