Pain NeurosurgeryPub Date : 2019-07-01DOI: 10.1093/MED/9780190887674.003.0017
Zoe E. Teton, A. Raslan
{"title":"Postherpetic Neuralgia of the Trigeminal Nerve (Trigeminal Tractotomy-Nucleotomy)","authors":"Zoe E. Teton, A. Raslan","doi":"10.1093/MED/9780190887674.003.0017","DOIUrl":"https://doi.org/10.1093/MED/9780190887674.003.0017","url":null,"abstract":"Trigeminal tractotomy-nucleotomy (TR-NC) is an effective operation in conditions where peripheral ablation would not be effective or when pain is due to involvement of multiple cranial nerves. Lesioning of the entire nucleus caudalis at the dorsal root entry zone (DREZ) represents a more extensive version of TR-NC. Here the focus is on the less invasive, percutaneous TR-NC or “mini-caudalis DREZ”. The target of TR-NC is the lateral descending trigeminal tract and nucleus caudalis of the spinal trigeminal nucleus. In select patient populations, careful lesion creation can be highly effective in providing immediate and long-lasting pain relief, with minimal adverse effects, lower cost and shorter hospital stays.","PeriodicalId":372220,"journal":{"name":"Pain Neurosurgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125762734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain NeurosurgeryPub Date : 2019-07-01DOI: 10.1093/MED/9780190887674.003.0001
O. Sagher
{"title":"Idiopathic Trigeminal Neuralgia in the Healthy Patient","authors":"O. Sagher","doi":"10.1093/MED/9780190887674.003.0001","DOIUrl":"https://doi.org/10.1093/MED/9780190887674.003.0001","url":null,"abstract":"Abstract: Idiopathic trigeminal neuralgia is one of the most common pain syndromes encountered in a typical neurosurgical practice. The approach to these patients is nuanced, and is based on their overall health status, the characteristics of their pain, and the distribution of symptoms. This chapter describes the assessment of a healthy patient with trigeminal neuralgia and provides key differential diagnoses of this pain syndrome. The counseling of the patient regarding treatment options is also described. Finally, the chapter outlines the operative management of a healthy patient using a microvascular decompression (MVD), including surgical pearls and strategies for complication avoidance and management.","PeriodicalId":372220,"journal":{"name":"Pain Neurosurgery","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132437420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain NeurosurgeryPub Date : 2019-07-01DOI: 10.1093/MED/9780190887674.003.0022
Innocent U. Njoku, J. Pilitsis
{"title":"Post-Stroke Intractable Pain","authors":"Innocent U. Njoku, J. Pilitsis","doi":"10.1093/MED/9780190887674.003.0022","DOIUrl":"https://doi.org/10.1093/MED/9780190887674.003.0022","url":null,"abstract":"Deep brain stimulation (DBS) has been used as a mode to treat chronic intractable pain by targeting the ventroposterior (VP) thalamus, the periaqueductal gray (PAG), or the anterior cingulate cortex (ACC). The exact underlying mechanism by which these targets produce an analgesic effect remains unclear, but stimulation of the thalamocortical pathways, alteration of thalamic activity, and interference of the pain relay pathway have been postulated as plausible mechanisms. Motor cortex stimulation (MCS) has also been used for the treatment of intractable pain through stimulation of the primary motor cortex. Intermittent electrical stimulation is delivered at thresholds lower than evoking a motor response but adequate enough to provide variable analgesic effects. We present a case to illustrate the diagnostic work-up, surgical technique, complications, and outcomes of (sub)cortical electrical stimulation for central pain syndrome.","PeriodicalId":372220,"journal":{"name":"Pain Neurosurgery","volume":"151 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122970591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain NeurosurgeryPub Date : 2019-07-01DOI: 10.1093/MED/9780190887674.003.0021
Roy Hwang, Claire Collison, J. Pilitsis
{"title":"Complex Regional Pain Syndrome Diagnosis and Surgical Management","authors":"Roy Hwang, Claire Collison, J. Pilitsis","doi":"10.1093/MED/9780190887674.003.0021","DOIUrl":"https://doi.org/10.1093/MED/9780190887674.003.0021","url":null,"abstract":"The prognosis and treatment of complex regional pain syndrome (CRPS) are for the most part disappointing and there exists few prospective studies in this area. The overall goal of treatment is functional restoration and improved quality of life by desensitization, reactivation, flexibility and strength training, ergonomics, and functional rehabilitation. Here we present a case of a patient with a diagnosis of CRPS type I after an orthopedic procedure and subsequent surgical management of her condition. We review the assessment and management of the patient, aftercare, and complication management. We also briefly review the current literature regarding the functional outcome for the surgical management of CRPS and future directions, including DRG stimulation.","PeriodicalId":372220,"journal":{"name":"Pain Neurosurgery","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114752748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain NeurosurgeryPub Date : 2019-07-01DOI: 10.1093/med/9780190887674.003.0004
O. Sagher
{"title":"Glossopharyngeal Neuralgia","authors":"O. Sagher","doi":"10.1093/med/9780190887674.003.0004","DOIUrl":"https://doi.org/10.1093/med/9780190887674.003.0004","url":null,"abstract":"Glossopharyngeal neuralgia is an uncommon, but devastating pain condition. It shares many features with trigeminal neuralgia, but predominantly affects the posterior tongue and pharynx. Since glossopharyngeal neuralgia pain is frequently triggered by swallowing or movement of the tongue, patients frequently present with weight loss and dehydration. This chapter describes the classic features of this condition, including its association with syncope. The medical management of glossopharyngeal neuralgia is outlined as a primary treatment modality. Surgical considerations are also described, including microvascular decompression or sectioning of the glossopharyngeal nerve. Surgical pearls for both of these procedures are outlined, as well as strategies for complication avoidance and management.","PeriodicalId":372220,"journal":{"name":"Pain Neurosurgery","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133656102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain NeurosurgeryPub Date : 2019-07-01DOI: 10.1093/MED/9780190887674.003.0006
Sebastian Rubino, Roy Hwang, J. Pilitsis
{"title":"Postherpetic Neuralgia","authors":"Sebastian Rubino, Roy Hwang, J. Pilitsis","doi":"10.1093/MED/9780190887674.003.0006","DOIUrl":"https://doi.org/10.1093/MED/9780190887674.003.0006","url":null,"abstract":"Postherpetic neuralgia (PHN) after acute herpes zoster ophthalmicus involves unilateral pain persisting or recurring for at least 3 months in the distribution of one or more branches of the trigeminal nerve. Patients often describe the pain associated with PHN as a deep aching or burning, dysesthetic, hyperesthetic, or electric shock-like sensation. The incidence of PHN increases with age and varies from 7 to 27%, depending on age group.\u00001\u0000 A subset of these patients develops medication-refractory PHN and should be referred for neurosurgical evaluation. Motor cortex stimulation (MCS) and trigeminal nucleus caudalis dorsal root entry zone (NC DREZ) lesioning are two therapies that may provide substantial relief to patients suffering from medication-refractory, postherpetic neuropathic facial pain.","PeriodicalId":372220,"journal":{"name":"Pain Neurosurgery","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121088833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain NeurosurgeryPub Date : 2019-07-01DOI: 10.1093/MED/9780190887674.003.0020
C. Cheyuo, Roy Hwang, J. Pilitsis
{"title":"Occipital Nerve Stimulation for Chronic Refractory Migraine","authors":"C. Cheyuo, Roy Hwang, J. Pilitsis","doi":"10.1093/MED/9780190887674.003.0020","DOIUrl":"https://doi.org/10.1093/MED/9780190887674.003.0020","url":null,"abstract":"Chronic migraine remains disabling for a significant proportion of the population and challenging for medical providers. In addition to pharmacological treatment, peripheral nerve stimulation has been shown to provide satisfactory pain relief and improved quality of life. In this chapter, an illustrative case of occipital nerve stimulation (ONS) for refractory chronic migraine is presented, including the preoperative assessment and planning, decision making process, detailed surgical technique, aftercare and follow-up. A complication and its management are also described and discussed in detail and supplemented with clinical pearls. This discussion is accompanied by a review of the relevant evidence and outcomes from the literature.","PeriodicalId":372220,"journal":{"name":"Pain Neurosurgery","volume":"112 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115686118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain NeurosurgeryPub Date : 2019-07-01DOI: 10.1093/MED/9780190887674.003.0009
D. Cleary, Sharona Ben-Haim
{"title":"Dorsal Root Entry Zone Lesioning for Brachial Plexus Avulsion Pain","authors":"D. Cleary, Sharona Ben-Haim","doi":"10.1093/MED/9780190887674.003.0009","DOIUrl":"https://doi.org/10.1093/MED/9780190887674.003.0009","url":null,"abstract":"Brachial plexus avulsion is often seen after motorcycle accidents or with high-speed ejection injuries. Rehabilitation focuses on regaining motor and sensory function, but the detrimental effect of pain is often underappreciated. Up to 90% of patients with avulsion injury will experience deafferentation pain, which until relatively recently has been difficult to treat medically or surgically. DREZotomy, the ablation of neurons in the dorsal root entry zone of the spinal cord, was introduced in the 1970s and has since changed how we treat brachial plexus avulsion and other forms of neuropathic pain. The procedure is straightforward: with a standard cervical approach, a hemilamiotomy is used to expose the area of interest. The dura is opened, and areas of root avulsion are identified. Using bipolar cautery, RF ablation, or ultrasound, the 2nd order neurons in dorsal horn are destroyed for the affected dermatomes. Complications include standard cervical spinal approach-related issues, such as infection, hematoma, CSF leak, and kyphosis. Risks specific to the procedure include post-operative motor or sensory deficits, due to the proximity of the corticospinal tracts and the dorsal columns to dorsal horn. As many as 18% of patients report a long-term neurological deficit post-operatively, but despite these complications, 80% of patients say they would repeat the procedure. Multiple outcomes series have been published since the procedure was introduced, and typically 70–80% of patients receive benefit from the procedure.","PeriodicalId":372220,"journal":{"name":"Pain Neurosurgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132833754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain NeurosurgeryPub Date : 2019-07-01DOI: 10.1093/med/9780190887674.003.0016
E. Levin
{"title":"Cluster Headache","authors":"E. Levin","doi":"10.1093/med/9780190887674.003.0016","DOIUrl":"https://doi.org/10.1093/med/9780190887674.003.0016","url":null,"abstract":"Cluster headache, a trigeminal autonomic cephalgia, is a syndrome involving unilateral head pain associated with autonomic symptoms. The diagnosis is clinical. The pathophysiology of cluster headache is unknown. It is believed to involve the trigeminal nerve and ganglion, with autonomic dysfunction and vascular irritability. Initial treatment is with parenteral triptans and inhaled oxygen. Preventive agents include topiramate, verapamil, and lithium. Occipital nerve blocks and stimulation have been effective in small studies. Surgery is limited to those patients that have persistent, chronic cluster headache with a minimum of three attacks per week, despite treatment with at least three preventative agents. Deep brain stimulation of the posterior hypothalamus has been shown to be effective in the treatment of chronic cluster headache.","PeriodicalId":372220,"journal":{"name":"Pain Neurosurgery","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122223223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain NeurosurgeryPub Date : 2019-07-01DOI: 10.1093/MED/9780190887674.003.0010
M. Bercu, T. Shepherd, A. Mogilner
{"title":"Percutaneous Cordotomy for Cancer-Associated Pain","authors":"M. Bercu, T. Shepherd, A. Mogilner","doi":"10.1093/MED/9780190887674.003.0010","DOIUrl":"https://doi.org/10.1093/MED/9780190887674.003.0010","url":null,"abstract":"Percutaneous cordotomy is well-established as a safe and effective treatment of cancer-associated pain. It remains a first-line treatment in countries where more expensive treatments such as implantable neurostimulators and pumps are not routinely available. We present a case report of a patient with metastatic adenocarcinoma of the esophagus and refractory right upper extremity pain, who was successfully treated via percutaneous CT-guided cordotomy. The procedure was completed in an outpatient setting; the patient was discharged after several hours, with immediate pain relief. He continued to benefit from the procedure for several months until he succumbed to his disease. The technique, decision making, complication profile, as well as the existing experience are presented and discussed in detail.","PeriodicalId":372220,"journal":{"name":"Pain Neurosurgery","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124103605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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