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Management of medically intractable genitofemoral and ilioingunal neuralgia.

AIM: To evaluate the effectiveness of invasive procedures in medically intractable genitofemoral and ilioingunal neuralgia. MATERIAL AND METHODS: This is a prospective study of 20 patients with genitofemoral and ilioinguinal neuralgias who were treated at our medical center between 2007 and 2011. Genitofemoral and ilioinguinal nerve blocks were performed in all cases after medical treatment had failed to alleviate the patients' pain. Neurectomy was performed for the patients whose pain did not improve. Patient histories, physical examinations and visual analogue scale scores before and after …

Управление герпесом Зостером и постгерпетической нейронгией.

Герпес зостер и его продолжение послегерпетической нейронгии (PHN) являются условиями с высокой заболеваемостью. ПХН представляет собой хроническую, изнуряющую нейропотическую боль, которая может сохраняться далеко за пределами разрешения видимых резких проявлений. В настоящем документе содержатся практические руководящие принципы управления герпесом-зостером и ПХН. Для герпеса-зостера противовирусные препараты должны начинаться, предпочтительно в течение 72 часов с момента начала, с тем чтобы уменьшить остроту и продолжительность изверженной фазы и уменьшить интенсивность острой боли. С ПХН м

Совпадение в аннотации оригинала
Herpes zoster and its sequela post-herpetic neuralgia (PHN) are conditions with significant morbidity. PHN is a chronic, debilitating neuropathic pain that can persist long beyond resolution of visible cutaneous manifestations. This paper provides practical guidelines for management of herpes zoster and PHN. For herpes zoster, antivirals should be started, p…

Peripheral nerve stimulation for occipital neuralgia: surgical leads.

Peripheral nerve stimulation (PNS) has been used for the treatment of various neuropathic pain disorders, including occipital neuralgia, for the patients who failed less-invasive therapeutic approaches. Several different mechanisms of pain relief were proposed when PNS is used to treat occipital neuralgia and clinical studies using various types of electrical leads suggested largely positive clinical responses in patients with mostly refractory, severe neuropathic pain. With advancements in cylindrical lead design for PNS and placement/implantation techniques, there are very few clear indicati…

Gamma knife radiosurgery for glossopharyngeal neuralgia: Marseille experience.

PURPOSE: Although Gamma Knife radiosurgery (GKR) is widely recognized as an effective and minimally invasive treatment for intractable trigeminal neuralgia, its role in glossopharyngeal neuralgia (GPN) has not yet been determined. METHODS: Between January 2002 and February 2009, 7 patients with medically intractable GPN were treated using GKR. Indication for GKR was the presence of medically intractable GPN, patient's refusal for open surgery or contraindication to microvascular decompression. Patients underwent preoperative investigation and were evaluated postoperatively with periodic asses…

CyberKnife stereotactic radiosurgical rhizotomy for refractory trigeminal neuralgia.

Stereotactic radiosurgery (SRS) has been established as an option for the treatment of trigeminal neuralgia (TN). Here, we report our experience of CyberKnife®-based (Accuray, Sunnyvale, CA, USA) stereotactic rhizotomy on medically refractory patients to determine its clinical effectiveness. Between January 2007 and December 2009, 14 selected patients underwent SRS for TN at our CyberKnife Center. Patients were evaluated for pain relief using a visual analog scale (VAS) score, time to reach pain relief (latency), duration of pain control, decrease of pain medication, occurrence of new dysesthe…

Case series: non vascular considerations in trigeminal neuralgia.

An abnormal vascular course of the superior cerebellar artery is often cited as the cause for trigeminal neuralgia. However, among patients with TN-like symptoms, 6% to 16% are variously reported to have intracranial tumours. Aneurysms, tumours, or other lesions may impinge or irritate the trigeminal nerve along its course. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. We would like to present a series of unusual lesions, all of which initially presented with neuralgic-like symptoms and were refractory to treatment. Collated case series with photographs a…

Atypical trigeminal neuralgia: a consequence of central sensitization?

Trigeminal neuralgia (TN) is characterized by sudden, recurrent, usually unilateral, severe brief stabbing pains in the distribution of trigeminal nerve. Although it is widely accepted that blood vessel or tumor compression contributes to paroxysms of TN, the pathogenesis of persistent background pain in atypical TN patient is unclear. Central sensitization is pain hypersensitivity caused by central neural plasticity. It is responsible for many temporal and symptomatic features of acute and chronic pain. We hypothesize that central sensitization might account for some symptoms of atypical TN. …

Trigeminal neuralgia and chiropractic care: a case report.

The following case describes a 68 year-old woman with a 7(1/2) year history of worsening head and neck pain diagnosed as trigeminal neuralgia following surgical resection of a brain tumor. After years of unsuccessful management with medication and physical therapies, a therapeutic trial of chiropractic was carried out. Chiropractic care included ultrasound, manual therapies (manipulation and mobilization), soft tissue therapies, and home stretching exercises. After an initial treatment period followed by 18 months of supportive care the patient reported satisfactory improvement. It became evid…

Cervical facet arthropathy and occipital neuralgia: headache culprits.

Cervicogenic headache (CH) is pain referred from the neck. Two common causes are cervical facet arthropathy and occipital neuralgia. Clinical diagnosis is difficult because of the overlying features between primary headaches such as migraine, tension-type headache, and CH. Interventional pain physicians have focused on supporting the clinical diagnosis of CH with confirmatory blocks. The treatment of cervical facet arthropathy as the source of CH is best approached with a multidimensional plan focusing on physical therapy and/or manual therapy. The effective management of occipital neuralgia r…

Trigeminal neuralgia secondary to meningioma of petroclival localization.

Trigeminal neuralgia is characterized by paroxysmal episodes of facial pain in the distribution of the trigeminal nerve. It can occur in either sex but is most frequently seen in women aged 50-60 years. This article presents case of trigeminal neuralgia in a 55-year-old female patient caused by meningioma of petroclival localization. The article underscores the importance of neurologic and neuroradiologic examination in diagnosing and managing patients with facial pain conditions.

Trigeminal neuralgia and pain related to multiple sclerosis.

Although many patients with multiple sclerosis (MS) complain of trigeminal neuralgia (TN), its cause and mechanisms are still debatable. In a multicentre controlled study, we collected 130 patients with MS: 50 patients with TN, 30 patients with trigeminal sensory disturbances other than TN (ongoing pain, dysaesthesia, or hypoesthesia), and 50 control patients. All patients underwent pain assessment, trigeminal reflex testing, and dedicated MRI scans. The MRI scans were imported and normalised into a voxel-based, 3D brainstem model that allows spatial statistical analysis. The onset ages of MS …

[Herpes zoster and postherpetic neuralgia - prevention by vaccination?].

Herpes zoster is caused by reactivation of latent varicella-zoster virus (VZV), which had remained latent in the dorsal root or cranial nerve ganglia since the primary infection. The risk of developing zoster increases significantly with age, the vast majority of zoster cases occuring in persons over 50 years. The most frequent and debilitating complication of zoster in immunocompetent patients is postherpetic neuralgia (PHN). In the absence of antiviral therapy, clinical studies have found up to 30 - 45 % of persons over 60 years of age to experience pain persisting for more than 6 months. Sy…

Preoperative visualization of neurovascular anatomy in trigeminal neuralgia.

OBJECT: The authors report on a novel technique to identify neurovascular compression in trigeminal neuralgia (TN). Using 3D reconstructed high-resolution balanced fast-field echo (BFFE) images fused with 3D time-of-flight (TOF) magnetic resonance (MR) angiography and Gd-enhanced 3D spoiled gradient recalled sequence, it is possible to objectively visualize the trigeminal nerve and nearby arteries and veins. METHODS: Magnetic resonance imaging was performed in 18 patients with unilateral TN using 3 sequences: BFFE, 3D TOF angiography, and 3D Gd-enhanced imaging. The images were imported into …