Two Cases of Medically and Surgically Intractable Sunct: A Reason for Caution and an Argument for A Central Mechanism

Cephalalgia ◽  
2002 ◽  
Vol 22 (3) ◽  
pp. 201-204 ◽  
Author(s):  
DF Black ◽  
DW Dodick
Keyword(s):  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Surgical Trauma ◽  
Significant Morbidity ◽  
Unilateral Deafness ◽  
Root Exit Zone ◽  
The Central Nervous System ◽  
Trigeminal Root ◽  
Anaesthesia Dolorosa

We report two cases of SUNCT that demonstrate the medically and surgically refractory nature of this disorder and support the hypothesis that the causative ‘lesion’ lies within the central nervous system. After both patients had failed medical therapies, the first underwent a glycerol rhizotomy, gammaknife radiosurgery and microvascular decompression of the trigeminal nerve. The second patient underwent gammaknife radiosurgery of the trigeminal root exit zone and two microvascular decompression surgeries. Neither patient benefited from these procedures. Currently, the first patient suffers from anaesthesia dolorosa and the second patient from unilateral deafness, chronic vertigo and dysequilibrium as a result of surgical trauma. These cases of SUNCT highlight the uncertainty regarding the role of surgery given the potential for significant morbidity. These cases also suggest that SUNCT originates and may be maintained from within the CNS and this central locus explains why SUNCT is not typically amenable to interventions aimed at the peripheral portion of the trigeminal nerve.

scholarly journals MICROVASCULAR DECOMPRESSION IN THE TREATMENT OF PATIENTS WITH TRIGEMINAL NEURALGIA

2019 ◽  
Vol 19 (1-2) ◽  
pp. 101-106
Author(s):  
D. M Lazarchuk ◽  
G. N Alekseev ◽  
O. O Kamadey ◽  
S. N Chemidronov
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Nerve Root ◽  
Treatment Method ◽  
Neurovascular Conflict ◽  
Neurosurgical Department ◽  
Trigeminal Nerve Root ◽  
Trigeminal Root ◽  
Cranial Fossa

This work highlights the main variant treatment of patients with trigeminal neuralgia, with a proven neurovascular conflict, microvascular decompression of the trigeminal root. Microvascular decompression is the main radical treatment method which allows to relieve hyperfunctional syndrome manifested by prosopalgia. In the course of this study, the variant anatomy of the neurovascular conflict in patients with trigeminal neuralgia was described in detail. The group of patients whose clinical diagnosis at the stage of selection was based on a neurological examination and taking into account the progression of symptoms as well as the performed instrumental examination (CT angiography). The results are described in the article. Atrophic changes of the root of the trigeminal nerve are visualized and described. The nature of its blood supply is classified according to the type of the origin of the artery or arterial branches of the trigeminal nerve root. The main types of neurovascular conflict classified according to the type of blood vessel are presented. Variant neuroanatomy of the trigeminal nerve root as well as the interaction with the arteries of the vertebrobasilar basin and the veins of the posterior cranial fossa are described. The course of microvascular decompression of the trigeminal nerve root, used in the neurosurgical department of Samara Regional Clinical Hospital n.a. V.D. Seredavin is described

Frameless linac-based stereotactic radiosurgery treatment for SUNCT syndrome targeting the trigeminal nerve and sphenopalatine ganglion

Cephalalgia ◽  
2013 ◽  
Vol 33 (13) ◽  
pp. 1132-1136 ◽  
Author(s):  
Daniel YH Tan ◽  
Eu Tiong Chua ◽  
Kim Bock Ng ◽  
Kwang Ping Chan ◽  
John Thomas
Keyword(s):  
Stereotactic Radiosurgery ◽  
Trigeminal Nerve ◽  
Sphenopalatine Ganglion ◽  
Sunct Syndrome ◽  
Non Invasive ◽  
Root Entry Zone ◽  
Functional Pain ◽  
Trigeminal Root

Background The short-lasting unilateral neuralgiform headache associated with conjunctival injection and tearing or SUNCT syndrome was first described in the 1970s. This paper is the first in the literature that describes the successful use of stereotactic radiosurgery (SRS) using a non-invasive frameless technique, targeting both the trigeminal nerve and the sphenopalatine ganglion in the management of intractable SUNCT. We also discuss the role of selecting peripheral targets in the management of this rare headache syndrome. Methods Among patients treated for functional pain disorders in our radiosurgery unit using the frameless technique since August 2011, one patient with symptoms matching the International Classification of Headache Disorders-2 (ICHD-II) criteria of SUNCT syndrome was identified. The multi-disciplinary case records of this patient were retrospectively reviewed and reported. Results Our patient had symptoms resembling the ICHD-II diagnostic criteria of SUNCT, which was refractory to medical treatment. Ninety Gy was delivered to the trigeminal root entry zone and 80 Gy was delivered to the sphenopalatine ganglion. At 16 months’ follow-up, she was pain free with minimal side effects. Conclusions Frameless linear accelerator (linac)-based SRS targeting the trigeminal nerve and sphenopalatine ganglion remained successful in our patient at 16 months. Longer follow-up and further experience will determine the efficacy and safety of this approach. We suggest that frameless SRS is a convenient and attractive non-invasive option for patients with medically refractory SUNCT.

scholarly journals On the treatment of postoperative urinary retention

1929 ◽  
Vol 25 (2) ◽  
pp. 211-212
Author(s):  
E. N. Avrova
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Urinary Retention ◽  
Surgical Trauma ◽  
Postoperative Urinary Retention ◽  
Conditioned Reflexes ◽  
Unusual Position ◽  
The Central Nervous System ◽  
Concentration Of Urine

Postoperative urinary retention is often a rather unpleasant and painful complication. This complication is observed more often during operations on the central nervous system, groin, perineum, rectum, external genital area, as well as in the large and especially the small pelvis. The role of this complication is attributed to several factors. Surgical trauma, intoxication of the nervous system from anesthesia and anesthesia (especially spinal), loss of conditioned reflexes associated with an unusual position of the patient on the back, and, finally, an increased concentration of urine can lead to dysfunction in the innervation of the bladder.

Clip-grafts in microvascular decompression of the posterior fossa

1986 ◽  
Vol 64 (4) ◽  
pp. 679-681 ◽  
Author(s):  
Edward R. Laws ◽  
Patrick J. Kelly ◽  
Thoralf M. Sundt
Keyword(s):  
Posterior Fossa ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Content Type ◽  
Trigeminal Root ◽  
Vascular Irritation ◽  
Sensory Root ◽  
Fine Print

✓ A method is described for the protection of the trigeminal root from recurrent vascular irritation or compression after posterior fossa microvascular decompression. A vascular clip-graft, using a Sundt clip of suitable size, is applied to the sensory root of the trigeminal nerve. The technique has proven safe and effective in a series of nine patients followed for up to 28 months.

Juvenile xanthogranuloma of the subdural spaces mimicking chronic hematoma with positive FDG uptake on PET: case report

2020 ◽  
Vol 26 (4) ◽  
pp. 449-453
Author(s):  
Jacob A. Kahn ◽  
Jeffrey T. Waltz ◽  
Ramin M. Eskandari ◽  
Cynthia T. Welsh ◽  
Michael U. Antonucci
Keyword(s):  
Potential Role ◽  
Response To Treatment ◽  
Juvenile Xanthogranuloma ◽  
Imaging Features ◽  
Limited Information ◽  
Advanced Imaging ◽  
Systemic Involvement ◽  
The Central Nervous System ◽  
Infancy And Early Childhood

The authors report an unusual presentation of juvenile xanthogranuloma (JXG), a non–Langerhans cell histiocytosis of infancy and early childhood. This entity typically presents as a cutaneous head or neck nodule but can manifest with more systemic involvement including in the central nervous system. However, currently there is limited information regarding specific imaging features differentiating JXG from other neuropathological entities, with diagnosis typically made only after tissue sampling. The authors reviewed the initial images of a young patient with shunt-treated hydrocephalus and enlarging, chronic, extraaxial processes presumed to reflect subdural collections from overshunting, and they examine the operative discovery of a mass lesion that was pathologically proven to be JXG. Their results incorporate the important associated histological and advanced imaging features, including previously unreported metabolic activity on FDG PET. Ultimately, the case underscores the need to consider JXG in differential diagnoses of pediatric intracranial masses and highlights the potential role of PET in the initial diagnosis and response to treatment.

Role of a nurse in the rehabilitation of children using ReviMotion hardware and software complex

2020 ◽  
pp. 49-56
Author(s):  
T. Shirshova
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
School Age Children ◽  
Equipment Management ◽  
School Age ◽  
Rehabilitation Process ◽  
Software Complex ◽  
Trained Personnel ◽  
The Central Nervous System

Disorders of the musculoskeletal system in school-age children occupy 1-2 places in the structure of functional abnormalities. Cognitive impairment without organic damage to the central nervous system is detected in 30-56% of healthy school children. Along with the increase in the incidence rate, the demand for rehabilitation systems, which allow patients to return to normal life as soon as possible and maintain the motivation for the rehabilitation process, is also growing. Adaptation of rehabilitation techniques, ease of equipment management, availability of specially trained personnel and availability of technical support for complexes becomes important.

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