Fig 1.The patient has reddish-brown patchy pigmentation on the left
upper eyelid, forehead, and crown, with scattered blisters on the skin
of the crown. Blurred vision and photophobia in her left eye. VAS
score:8-9.
2 | CASE
PRESENTATION
The patient was a female, 74 years old. More than 20 days ago, there was
no obvious inducement,but there was red herpes on the left forehead and
top. It was diagnosed as ”herpes zoster” in the local hospital.
Antiviral, nerve nourishing and analgesic drugs were given intravenously
to her. During the course of the disease, blurred vision and photophobia
gradually appeared in the left eye. One week later, the herpes subsided,
but the left forehead and orbit were still painful, with unclear vision
and photophobia in the left eye (Fig 1.). He was hospitalized in our
department and diagnosed as ”postherpetic neuralgia”. At admission, the
patient complained of paroxysmal pain in the left frontal top and orbit
, which was electric shock like. VAS score: 8-9 points, about 5 minutes
each time, with an interval of 1-2 hours. SF-36
score[3-5]: physiological function (PF): 65,
physiological function (RF): 0, Body pain (BP): 22, general health
status (GH): 57, energy (VT): 30, social function (SF): 22.22, emotional
function (RE): 0, mental health (MH): 44, health change (HT): 25;
Pittsburgh sleep quality index scale[6,7]: 19.
Patchy-like dark red pigmentation can be seen in the distribution area
of the first branch of the left trigeminal nerve, local tactility is
normal without obvious tenderness, photophobia in the left eye, visual
acuity is 0.2, no obvious abnormality in the right eye, visual acuity is
0.5. After admission, they were given ketochromate tromethamine 30mg
bid, esmeprazole 40mg bid, acyclovir 0.25g tid, Mecobalamin 500 ug qd
intravenously, and vaccinated with cowpox vaccine, rabbit inflammatory
skin extract 6ml qd; Oral pregabalin 75mg bid had poor pain control, and
there was no significant change in attack and pain degree.With the
consent of the patient, low temperature plasma nerve conditioning in the
distribution area of the first branch of the trigeminal nerve was
performed (Fig 2.). After entering the operating room, the patients were
routinely opened venous access and ECG monitoring. The appropriate
surgical position was selected according to the pain site, the pain site
was fully exposed, and the local routine disinfection and towel laying
were carried out. 20ml of 2% lidocaine + 20ml of 0.9% normal saline
were prepared into 1% local anesthetic (without adrenaline) for
subcutaneous local infiltration anesthesia. After the pain of local
infiltration anesthesia disappears, enter the needle with the No. 12
puncture needle inclined 15 ° with the skin. After reaching the
subcutaneous area, take out the puncture needle core, insert the plasma
knife head, connect the knife head with the plasma RF machine, adjust
the ablation intensity of the RF machine at level 3,
and the ablation time at each point
is electric cutting for 5S and electric coagulation for 5S. At the same
time, swing the needle tail left and right to increase the ablation
range. Every 0.5cm is an ablation
point, and ablation is performed while withdrawing the needle until all
the painful parts are ablated. Due to the large pain area of the
patient, the first operation is mainly in the most obvious areas of
supraorbital foramen, subcutaneous prefrontal and top pain on the
affected side. The next day, the operation is performed again, mainly in
the most obvious areas above the hairline to the top pain. The operation
site was kept clean and dry for 48h. Two operations completely covered
the pain area of the patient.