Postherpetic craniofacial dysaesthesiae: Their management by stereotaxic trigeminal nucleotomy

Schvarcz, J. R.

doi:10.1007/bf01401543

Cited by 30 publications

(11 citation statements)

References 21 publications

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“…Schvarcz 6,7 then transformed the procedure into a percutaneous approach by using a special stereotactic apparatus designed for craniocervical junction lesioning such as tractotomy and myelotomy. Lesioning of the tract and nucleus, which is universally ablated because of its proximity to the tract, is essential for treating cancerassociated pain of the face and neuropathic facial pain syndromes or anesthesia dolorosa.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous trigeminal tractotomy–nucleotomy with use of intraoperative computed tomography and general anesthesia: report of 2 cases

Thompson

Burchiel²,

Raslan³

2013

FOC

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For confirming the correct location of the radiofrequency electrode before creation of a lesion, percutaneous CT-guided trigeminal tractotomy–nucleotomy is most commonly performed with the patient prone and awake. However, for patients whose facial pain and hypersensitivity are so severe that the patients are unable to rest their face on a support (as required with prone positioning), awake CT-guided tractotomy-nucleotomy might not be feasible. The authors describe 2 such patients, for whom percutaneous intraoperative CT-guided tractotomy-nucleotomy under general anesthesia was successful. One patient was a 79-year-old man with profound left facial postherpetic neuralgia, who was unable to tolerate awake CT-guided tractotomy-nucleotomy, and the other was a 45-year-old woman with intractable hemicranial pain that developed after a right frontal lesionectomy for epilepsy. Each patient underwent a percutaneous intraoperative CT-guided tractotomy-nucleotomy under general anesthesia. No complications occurred, and each patient reported excellent pain relief for up to 6 and 3 months after surgery, respectively. Percutaneous intraoperative CT-guided tractotomy-nucleotomy performed on anesthetized patients is effective for facial postherpetic neuralgia and postoperative hemicranial neuralgia.

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Section: Discussionmentioning

confidence: 99%

Percutaneous trigeminal tractotomy–nucleotomy with use of intraoperative computed tomography and general anesthesia: report of 2 cases

Thompson

Burchiel²,

Raslan³

2013

FOC

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“…The procedure then underwent a series of modifications until Crue et al [15,16] in 1967 and Hitchcock [17] in 1968 independently developed a stereotactic radiofrequency (RF) electrode for lesioning the trigeminal tract. In 1975 and 1977, Schvarcz [18,19] used the same procedure to create lesions primarily in the nucleus caudalis at the level of craniocervical junction and named that procedure trigeminal nucleotomy. Gorecki [20] and colleagues [21,22] and Nashold et al [23] described an open surgical procedure in which the substantia gelatinosa was destroyed extensively with RF between the dorsal root of C2 and 5 mm above the obex.…”

Section: Trigeminal Tractotomy-nucleotomymentioning

confidence: 99%

Neurosurgical Advances in Cancer Pain Management

Raslan

Burchiel

2010

Curr Pain Headache Rep

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Neurosurgical procedures to treat pain are mainly destructive and involve the spinal cord and occasionally the brain. Targets include the spinothalamic tract, the trigeminal tract nucleus, the midline ascending visceral pain pathway, the brainstem spinal lemniscus, the thalamus, and the cingulate gyrus. Since the introduction of intrathecal opioids, the need for neurosurgical destructive procedures has been in decline. In recent years, cordotomy, trigeminal tractotomy, and dorsal root entry zone (DREZ) operations are the neurosurgical procedures most often utilized to treat cancer pain. The addition of CT guidance to spinal cord pain pathway ablation was a major addition and refinement to the procedure. Here the authors review the latest techniques and recently published results for CT-guided cordotomy, CT-guided trigeminal tractotomy, and DREZ operations utilized to treat cancer pain.

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“…In their paper they indicated that the accompanying trigeminal nucleus destruction might be responsible for the good results obtained in treating postherpetic neuralgia. Later Schvarcz approached the oral pole of the subnucleus caudalis at the level of occipito-cervical junction and named the procedure trigeminal nucleotomy 1~ Nucleus caudalis lesions are still performed with the help of multiple RF lesions for central trigeminal pain states by CI C2 laminectomy and a small occipital craniectomy 1 ' 12 Trigeminal tractotomy and/or nucleotomy are now used for pain denervation in selected cases, especially for cancerogenic and deafferentative pains located in the areas of the 5th, 7th, 9th and 10th nerves ~' z, 3,4,7,9,11,12,14 In stereotactic trigeminal tractotomy, x-ray is the classical imaging method used for placing the electrode in the chosen target. Despite accompanying contrast agents, this visualization method can only indirectly specify the target electrode relationship.…”

Section: Introductionmentioning

confidence: 99%