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Anesthesia Dolorosa

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J R Schvarcz – 1st expert on this subject based on the ideXlab platform

  • stereotactic trigeminal nucleotomy for dysesthetic facial pain
    Stereotactic and Functional Neurosurgery, 1997
    Co-Authors: J R Schvarcz


    Trigeminal nucleotomy is a relatively simple, straightforward stereotactic procedure, acting at the deafferentation site, i.e., at the nucleus caudalis. Patients were operated on in a seated position, by a posterior suboccipital approach. Out of a series of 196 patients, 143 underwent trigeminal nucleotomy for deafferentation. Clinical diagnoses were 52 cases of postherpetic pain dysesthesia, 35 of Anesthesia Dolorosa, 46 of dysesthetic state with superimposed tic-like sequelae of trigeminal surgery performed elsewhere and 9 of posttraumatic neuropathy. Abolition of allo-dynia or marked reduction in, or disappearance of deep background pain was achieved in 72.0% of the cases overall. Results are analyzed for each clinical category. There were no side effects of any kind. Follow-up ranged from 4 to 17 years. This seems to be the procedure of choice for deafferentation facial pain.

Sergio Canavero – 2nd expert on this subject based on the ideXlab platform

  • how frequent is Anesthesia Dolorosa following spinal posterior rhizotomy a retrospective analysis of fifteen patients
    Pain, 1993
    Co-Authors: C A Pagni, Michele Maria Rosario Lanotte, Sergio Canavero


    Abstract Anesthesia Dolorosa has been considered an unfrequent complication of spinal posterior rhizotomy. We reviewed the data of all patients who underwent rhizotomy between 1962 and 1972 (15 cases). Thirteen were affected by cancer and 2 by non-neoplastic conditions. Eight developed a typical deafferentation pain (i.e., Anesthesia Dolorosa) (53%) while 3 who were found to have a brain (frontal 2; parietal 1) metastasis did not. Anesthesia Dolorosa developed 1.5–8 months after rhizotomy. We conclude that Anesthesia Dolorosa following rhizotomy is more frequent than usually stated and that rhizotomy should be restricted to patients with a less than 3-month life expectancy.

  • The role of cortex in central pain syndromes: preliminary results of a long-term technetium-99 hexamethylpropyleneamineoxime single photon emission computed tomography study.
    Neurosurgery, 1993
    Co-Authors: Sergio Canavero, Carlo Alberto Pagni, Giancarlo Castellano, Vincenzo Bonicalzi, Marilena Bellò, Sergio Duca, Valerio Podio


    : The role of the somatosensory cortex in central pain syndromes is widely questioned. Two recent position emission tomography studies detected a strong activation of the parietal and cingular cortices after brief nociceptive stimuli. On the other hand, a recent single photon emission computed tomography study found no cortical activation in five patients affected by central poststroke pain and algodystrophia. In this study, we present the single photon emission computed tomography findings in five patients suffering from central pain syndromes. Two of these, one with facial postrhizotomy Anesthesia Dolorosa and the other with central poststroke pain, showed a decrease of blood flow in the parietal lobe, further decreasing after stimulation by nonpainful maneuvers. Our results suggest that somatosensory cortical areas might be involved in the generation of anomalous pain states in some cases of central pain syndromes.

Amr O Elnaggar – 3rd expert on this subject based on the ideXlab platform

  • nucleus caudalis dorsal root entry zone lesioning for the treatment of Anesthesia Dolorosa
    Journal of Neurosurgery, 2013
    Co-Authors: Stephen Sandwell, Amr O Elnaggar


    Deafferentation facial pain (Anesthesia Dolorosa) can occur after injury of the first-order trigeminal nerve. It is often debilitating and difficult to treat. The authors report the treatment of Anesthesia Dolorosa in a 69-year-old man with a 7-year history of pain. The pain occurred after an open resection of a right trigeminal neuroma. After treatment with medications failed, the patient was treated with nucleus caudalis (dorsal root entry zone) lesioning. His facial pain was immediately and completely eliminated. The authors describe the technique of this central neuroablative procedure, and they review the available literature regarding this procedure as well as the current evidence base for neuromodulatory surgeries. After the 1-year follow-up, the authors conclude that the patient attained lasting relief.