Gamma Knife Radiosurgery for Short Unilateral Neuralgiform Headache Attacks with Conjunctival injection and Tearing (SUNCT) Syndrome: Targeting the Trigeminal Nerve and the Sphenopalatine Ganglion. Case Report and Literature Review.

Abstract Background Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a primary headache syndrome with an unclear pathogenesis, and only in very few cases, SUNCT is secondary to known lesions (secondary SUNCT). Several pharmacological as well as interventional and invasive treatments have been used to treat SUNT cases, with no definitive results. We describe a patient with idiopathic SUNCT syndrome, successfully treated with gamma knife radiosurgery (GKRS) and we report a review of the cases of the literature treated with radiosurgery. Case report A 63 year-old woman complained of episodes of intense and regular paroxysmal facial pain in the territory of the maxillary branch of trigeminal nerve (TN) accompanied by inflammation of conjunctiva and involuntary lacrimation from 2006. During the following years she received several treatments: combination of drugs, agopuncture, and endonasal infiltration of the sphenopalatine ganglion (SPG). The frequency of the painful attacks increased progressively and was impossible for her to have a normal active life. A combined GKRS treatment, targeting the TN (80 Gy max dose) and the SPG (80 Gy max dose) was performed on April 2016 (Visual Analog Score, VAS, before treatment = 6). Pain gradually reduced in the following months, as well as frequency and severity of the attacks. No sensory deficit developed. The follow-up length of our patient is 37 months: she is nearly pain free (VAS=2) and had resumed a normal life. Conclusions Patients with idiopathic SUNCT have few therapeutic options. Our case demonstrates that gamma knife radiosurgery is a feasible and effective non-invasive option to treat patient with medically refractory idiopathic SUNCT.