Trigeminal neuralgia (TN) is a severe neuropathic condition that affects several elderly patients. It is characterized by uncontrolled pain that significantly impacts the quality of life of patients. Therefore, the condition should be treated as an emergency. In the majority of patients, pain can be controlled with medication; however, other treatment modalities are being explored in those who become refractory to drug treatment. The use of the trigeminal nerve block with a local anesthetic serves as an excellent adjunct to drug treatment. This technique rapidly relieves the patient of pain while medications are being titrated to effective levels. We report the efficacy and safety of percutaneous trigeminal nerve block in elderly patients with TN at our outpatient clinic.Twenty-one patients older than 65 years with TN received percutaneous nerve block at our outpatient clinic. We used bupivacaine (1 mL/injection site) to block the supraorbital, infraorbital, superior alveolar, mental, and inferior alveolar nerves according to pain sites of patients.All patients reported relief from pain, which decreased by approximately 78% after 2 weeks of nerve block. The effect lasted for more than 4 weeks in 12 patients and for 6 weeks in two patients. There were no complications.Percutaneous nerve block procedure performed at our outpatient clinic provided immediate relief from pain to elderly patients with TN. The procedure is simple, has no serious side effects, and is easy to apply.
Abstract Background Recently, stereotacitc radiosurgery (SRS) has been in the spotlight as an alternative therapeutic option for jugular foramen schwannomas (JFS). While most reported studies focus on the long-term efficacy and safety issues of SRS, none describe the early-onset adverse events (eAEs). We aimed to investigate the incidence, clinical characteristics, and mid-term outcomes of eAEs occurring within six months after SRS for JFS. Methods In this retrospective review, patients who underwent at least six months of follow-up were included among all patients with JFS who have performed SRS at our institution between July 2008 and November 2019. And eAEs were defined as a newly developed neurological deficit or aggravation of pre-existing symptoms during the first six months after SRS. Results Forty-six patients were included in the analysis. The median follow-up period was 50 months (range 9–136). The overall tumor control rate was 91.3%, and the actuarial 3-, 5-, and 10-year progression-free survival rates were 97.8%, 93.8%, and 76.9%, respectively. Of the 46 patients, 16 had eAEs, and the median time to onset of eAEs was one month (range 1–6 months), and the predominant symptoms were lower cranial nerve dysfunctions. Thirteen of 16 patients showed improved eAE symptoms during the follow-up period, and the median resolution time was six months (range 1–52). In 11 (68.8%) of 16 patients with eAEs, transient expansions were observed with a mean of 3.6 months after the onset of eAEs, and the mean difference between the initial tumor volume and the transient expansion volume was more prominent in the patients with eAEs (3.2 cm 3 vs. 1.0 cm 3 ; p = 0.057). In univariate analysis, dumbbell-shaped tumors (OR 10.56; p = 0.004) and initial tumor volume (OR 1.32; p = 0.033) were significantly associated with the occurrence of eAEs. Conclusions Although acute adverse events after SRS for JFS are not rare, these acute effects were not permanent and mostly improved with the steroid treatment. Dumbell-shaped and large-volume tumors are significant predictive factors for the occurrence of eAEs. And the transient expansion also seems to be closely related to eAEs. Therefore, clinicians need to be more cautious when treating these patients and closely monitor the occurrence of eAEs.
Trigeminal neuralgia is caused by compression of blood vessels on the trigeminal nerve in 80–85% of cases. In this case, good results can be obtained by properly decompressing [1]. It is usually accessed to trigeminal nerve through the retrosigmoid approach. When the culprit vessel is identified, decompression is performed using decompressive materials such as Teflon. Sometimes a vein is the offending vessel, and sometimes the culprit vessel is not observed. In this case, rhizotomy or internal neurolysis is performed [2]. Nevertheless, the reasons for not performing invasive surgery are: (1) Various treatments other than surgery and good treatment results [3, 4]. (2) Surgical anatomy is unfamiliar and the operation field is narrow and deep. (3) There are factors that affect the difficulty of surgery, such as protrusion of petrosal bone and the route of superior petrosal vein. (4) The offending vessel was confirmed on the preoperative MR images and surgery was performed, but it is difficult to manage when there is no clear offender, or a small perforator or vein is the culprit vessel.
We report a case of spontaneous disappearance and recanalization of ruptured pericallosal artery aneurysm. A patient in her 40s presented with semicomatose mentality and massive intraventricular hematoma. Initial computed tomography angiogram (CTA) showed definite saccular aneurysm on pericallosal artery. But, cerebral angiography while attempting urgent coil embolization showed disappearance of the ruptured aneurysm along with thrombotic occlusion of parent artery. Then, the patient had been receiving conservative management in the intensive care unit. The CTA was repeated on hospitalization day (HD) 7 and 14. Recanalization was detected on CTA of HD 22. The ruptured aneurysm was obliterated with endovascular coiling on the HD 23. The aneurysm has been stable for 36 months. Careful surveillance for recanalization followed by delayed intervention will be crucial in the exceptional situations of a spontaneously disappearing aneurysm. Keywords: Subarachnoid hemorrhage; Intracranial aneurysm; Angiography, Digital subtraction.
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