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Yücel Kanpolat - One of the best experts on this subject based on the ideXlab platform.
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computed tomography guided percutaneous trigeminal tractotomy nucleotomy
Neurosurgery, 2008Co-Authors: Yücel Kanpolat, Gokmen Kahilogullari, Hasan Caglar Ugur, Atilla Halil ElhanAbstract:OBJECTIVE: The destruction of the descending trigeminal tractus in the medulla is known as trigeminal tractotomy (TR), whereas the lesioning of the nucleus caudalis is known as trigeminal nucleotomy (NC). Trigeminal TR and/or NC procedures can be used in a large group of pain syndromes, such as glossopharyngeal, vagal, and geniculate Neuralgias, atypical facial pain, craniofacial cancer pain, postherpetic Neuralgias, and atypical forms of trigeminal Neuralgia. METHODS: In this study, anatomic and technical details of the procedure and the experience gained from 65 patients over the course of 20 years are discussed. Patients' pain scores and Karnofsky Performance Scale scores were evaluated pre- and postoperatively (postoperative Day 1). RESULTS: The best results were obtained in the second-largest group (vagoglossopharyngeal Neuralgia, n = 17) and in geniculate Neuralgia (n = 4). Patients with atypical facial pain (n = 21; 13 women, eight men) accounted for the largest group to undergo computed tomography-guided TR-NC surgery; pain relief was achieved in 19 of these patients. In the third-largest group (craniofacial and oral cancer pain, n = 13), 11 of 13 patients were successfully treated with TR-NC. Four of five patients with failed trigeminal Neuralgia were also effectively treated with TR-NC. CONCLUSION: We propose that computed tomography-guided TR-NC provides direct visualization of the target-electrode relation and can be considered a first-step procedure in patient management. In view of its high efficacy, low complication rate, and minimal invasiveness, computed tomography-guided trigeminal TR-NC is a safe and effective procedure in the treatment of intractable facial pain syndromes.
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computed tomography guided trigeminal tractotomy nucleotomy in the management of vagoglossopharyngeal and geniculate Neuralgias
Neurosurgery, 1998Co-Authors: Yücel Kanpolat, Ali Savas, Funda Batay, Ahmet SinavAbstract:OBJECTIVE: Vagoglossopharyngeal and geniculate Neuralgias are less frequently seen types of cranial Neuralgias. Their causes and symptomatology are similar to those of trigeminal Neuralgia; however, the complex anatomic relationship between the intermedius, vagal, and glossopharyngeal nerves leads to difficulties in the diagnosis and management of Neuralgias originating from these cranial nerves. Numerous procedures have been used to treat intractable Neuralgias of the VIIth, IXth, and Xth cranial nerves: 1) extracranial sectioning of the cranial nerves, 2) percutaneous thermal rhizotomy, 3) intracranial glossopharyngeal and vagal rhizotomies, 4) microvascular decompression, and 5) percutaneous trigeminal tractotomy-nucleotomy (TR-NC) or nucleus caudalis dorsal root entry zone operation. We propose that computer-guided TR-NC may be the first-choice operation for patients with glossopharyngeal, vagal, or geniculate Neuralgia. PATIENTS AND METHODS: Nine patients suffering from idiopathic vagoglossopharyngeal Neuralgia (six patients) and geniculate Neuralgia (three patients) were managed at our clinic. Computed tomography-guided percutaneous trigeminal TR-NC was performed for these nine patients. RESULTS: Excellent (six patients) or good (three patients) pain control was obtained in each patient. Complications included temporary ataxia in two patients after TR-NC. CONCLUSION: The risk:benefit ratio should be evaluated individually to select the appropriate treatment procedure for patients with vagoglossopharyngeal and geniculate Neuralgias. Computed tomography-guided percutaneous TR-NC is an effective and minimally invasive procedure for such patients.
Julio Yangüela - One of the best experts on this subject based on the ideXlab platform.
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Supratrochlear Neuralgia: A Prospective Case Series of 15 Patients.
Headache, 2017Co-Authors: Juan A. Pareja, Pedro López-ruiz, Diego Mayo, Rocío-nur Villar-quiles, Alba Cárcamo, Álvaro Gutiérrez-viedma, Carlo P. Lastarria, María Romeral, Julio Yangüela, María Luz CuadradoAbstract:Objective The aim of this study was to describe clinical features unique to supratrochlear Neuralgia. Background The supratrochlear nerve supplies the medial aspect of the forehead. Due to the intricate relationship between supraorbital and supratrochlear nerves, neuralgic pain in this region has been traditionally attributed to supraorbital Neuralgia. No cases of supratrochlear Neuralgia have been reported so far. Methods From 2009 through 2016, we prospectively recruited patients with pain confined to the territory of the supratrochlear nerve. Results Fifteen patients (13 women, 2 men; mean age 51.4 years, standard deviation 14.9) presented with pain in the lower paramedian forehead, extending to the eyebrow in two patients and to the internal angle of the orbit in another. Pain was unilateral in 11 patients (six on the right, five on the left), and bilateral in four. Six patients had continuous pain and nine described intermittent pain. Palpation of the supratrochlear nerve at the medial third of the supraorbital rim resulted in hypersensitivity in all cases. All but one patient exhibited sensory disturbances within the painful area. Fourteen patients underwent anesthetic blockades of the supratrochlear nerve, with immediate relief in all cases and long-term remission in three. Six of them had received unsuccessful anesthetic blocks of the supraorbital nerve. Five patients were treated successfully with oral drugs and one patient was treated with radiofrequency. Conclusions Supratrochlear Neuralgia is an uncommon disorder causing pain in the medial region of the forehead. It may be differentiated from supraorbital Neuralgia and other similar headaches and Neuralgias based on the topography of the pain and the response to anesthetic blockade.
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Nummular headache, trochleitis, supraorbital Neuralgia, and other epicranial headaches and Neuralgias: the epicranias
The Journal of Headache and Pain, 2003Co-Authors: Juan A. Pareja, Julia Pareja, Julio YangüelaAbstract:Nummular headache is characterized by mild to moderate, pressure-like head pain exclusively in a small, rounded or oval area without underlying structural lesions. Either during symptomatic periods or interictally, the affected area shows a variable combination of hypoesthesia, dysesthesia, paresthesia, tenderness or discomfort. The particular topography and signs of sensory dysfunction suggest that nummular headache is an extracranial headache probably stemming from epicranial tissues such as the terminal branches of sensory nerves. Apart from nummular headache, other headaches and Neuralgias such as idiopathic stabbing headache, trochleitis, supraorbital Neuralgia, external compression headache, nasociliary Neuralgia, occipital Neuralgias, and auriculotemporal Neuralgia have temporal or spatial features that suggest a peripheral (extracranial) origin, i. e. stemming from the bone, scalp, or pericranial nerves. Common to these disorders is a focal localization or a multidirectional sequence of paroxysms, paucity of accompaniments, tenderness on the emergence or course of a pericranial nerve or on the tissues where pain originates, and possible presence of symptoms and signs (including effective treatment with locally injected anesthetics or corticosteroids) of nerve dysfunction. These observations led to the emergence of a conceptual model of head pain with an epicranial origin that we propose to group under the appellation of epicranias (headaches and pericranial Neuralgias stemming from epicranial tissues). Nummular headache is the paradigm of epicranias. Epicranias essentially differ from other primary headaches with an intracranial origin and features of visceral pain, i. e. splanchnocranias that are characterized by a painful area wider than that of epicranias, no clear borders, presence of autonomic features, regional muscle tension, and driving of the process from the brain and brainstem.
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Nummular headache, trochleitis, supraorbital Neuralgia, and other epicranial headaches and Neuralgias: the epicranias
The Journal of Headache and Pain, 2003Co-Authors: Juan A. Pareja, Ja Pareja, Julio YangüelaAbstract:Nummular headache is characterized by mild to moderate, pressure-like head pain exclusively in a small, rounded or oval area without underlying structural lesions. Either during symptomatic periods or interictally, the affected area shows a variable combination of hypoesthesia, dysesthesia, paresthesia, tenderness or discomfort. The particular topography and signs of sensory dysfunction suggest that nummular headache is an extracranial headache probably stemming from epicranial tissues such as the terminal branches of sensory nerves. Apart from nummular headache, other headaches and Neuralgias such as idiopathic stabbing headache, trochleitis, supraorbital Neuralgia, external compression headache, nasociliary Neuralgia, occipital Neuralgias, and auriculotemporal Neuralgia have temporal or spatial features that suggest a peripheral (extracranial) origin, i. e. stemming from the bone, scalp, or pericranial nerves. Common to these disorders is a focal localization or a multidirectional sequence of paroxysms, paucity of accompaniments, tenderness on the emergence or course of a pericranial nerve or on the tissues where pain originates, and possible presence of symptoms and signs (including effective treatment with locally injected anesthetics or corticosteroids) of nerve dysfunction. These observations led to the emergence of a conceptual model of head pain with an epicranial origin that we propose to group under the appellation of epicranias (headaches and pericranial Neuralgias stemming from epicranial tissues). Nummular headache is the paradigm of epicranias. Epicranias essentially differ from other primary headaches with an intracranial origin and features of visceral pain, i. e. splanchnocranias that are characterized by a painful area wider than that of epicranias, no clear borders, presence of autonomic features, regional muscle tension, and driving of the process from the brain and brainstem.
Juan A. Pareja - One of the best experts on this subject based on the ideXlab platform.
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Supratrochlear Neuralgia: A Prospective Case Series of 15 Patients.
Headache, 2017Co-Authors: Juan A. Pareja, Pedro López-ruiz, Diego Mayo, Rocío-nur Villar-quiles, Alba Cárcamo, Álvaro Gutiérrez-viedma, Carlo P. Lastarria, María Romeral, Julio Yangüela, María Luz CuadradoAbstract:Objective The aim of this study was to describe clinical features unique to supratrochlear Neuralgia. Background The supratrochlear nerve supplies the medial aspect of the forehead. Due to the intricate relationship between supraorbital and supratrochlear nerves, neuralgic pain in this region has been traditionally attributed to supraorbital Neuralgia. No cases of supratrochlear Neuralgia have been reported so far. Methods From 2009 through 2016, we prospectively recruited patients with pain confined to the territory of the supratrochlear nerve. Results Fifteen patients (13 women, 2 men; mean age 51.4 years, standard deviation 14.9) presented with pain in the lower paramedian forehead, extending to the eyebrow in two patients and to the internal angle of the orbit in another. Pain was unilateral in 11 patients (six on the right, five on the left), and bilateral in four. Six patients had continuous pain and nine described intermittent pain. Palpation of the supratrochlear nerve at the medial third of the supraorbital rim resulted in hypersensitivity in all cases. All but one patient exhibited sensory disturbances within the painful area. Fourteen patients underwent anesthetic blockades of the supratrochlear nerve, with immediate relief in all cases and long-term remission in three. Six of them had received unsuccessful anesthetic blocks of the supraorbital nerve. Five patients were treated successfully with oral drugs and one patient was treated with radiofrequency. Conclusions Supratrochlear Neuralgia is an uncommon disorder causing pain in the medial region of the forehead. It may be differentiated from supraorbital Neuralgia and other similar headaches and Neuralgias based on the topography of the pain and the response to anesthetic blockade.
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Lacrimal Neuralgia: So far, a missing cranial Neuralgia:
Cephalalgia : an international journal of headache, 2013Co-Authors: Juan A. Pareja, María Luz CuadradoAbstract:BackgroundThe lacrimal nerve supplies the lacrimal gland, the lateral upper eyelid, and a small cutaneous area adjacent to the external canthus. First division trigeminal Neuralgia, supraorbital/supratrochlear Neuralgia, and infraorbital Neuralgia have been acknowledged as neuralgic causes of pain in the forehead and periorbit. However, the lacrimal nerve has never been identified as a source of facial pain. Here we report two cases of lacrimal Neuralgia.Case reportsA 66-year-old woman had continuous pain in the lateral aspect of her left superior eyelid and an adjacent area of the temple since age 64. A 33-year-old woman suffered from continuous pain in a small area next to the lateral canthus of her left eye since age 25. In both patients the superoexternal edge of the orbit was tender. In addition, sensory dysfunction could be demonstrated within the painful area. Anaesthetic blockades of the lacrimal nerve with lidocaine 2% resulted in complete but short-lasting relief. Pregabalin provided a complete ...
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Nummular headache, trochleitis, supraorbital Neuralgia, and other epicranial headaches and Neuralgias: the epicranias
The Journal of Headache and Pain, 2003Co-Authors: Juan A. Pareja, Julia Pareja, Julio YangüelaAbstract:Nummular headache is characterized by mild to moderate, pressure-like head pain exclusively in a small, rounded or oval area without underlying structural lesions. Either during symptomatic periods or interictally, the affected area shows a variable combination of hypoesthesia, dysesthesia, paresthesia, tenderness or discomfort. The particular topography and signs of sensory dysfunction suggest that nummular headache is an extracranial headache probably stemming from epicranial tissues such as the terminal branches of sensory nerves. Apart from nummular headache, other headaches and Neuralgias such as idiopathic stabbing headache, trochleitis, supraorbital Neuralgia, external compression headache, nasociliary Neuralgia, occipital Neuralgias, and auriculotemporal Neuralgia have temporal or spatial features that suggest a peripheral (extracranial) origin, i. e. stemming from the bone, scalp, or pericranial nerves. Common to these disorders is a focal localization or a multidirectional sequence of paroxysms, paucity of accompaniments, tenderness on the emergence or course of a pericranial nerve or on the tissues where pain originates, and possible presence of symptoms and signs (including effective treatment with locally injected anesthetics or corticosteroids) of nerve dysfunction. These observations led to the emergence of a conceptual model of head pain with an epicranial origin that we propose to group under the appellation of epicranias (headaches and pericranial Neuralgias stemming from epicranial tissues). Nummular headache is the paradigm of epicranias. Epicranias essentially differ from other primary headaches with an intracranial origin and features of visceral pain, i. e. splanchnocranias that are characterized by a painful area wider than that of epicranias, no clear borders, presence of autonomic features, regional muscle tension, and driving of the process from the brain and brainstem.
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Nummular headache, trochleitis, supraorbital Neuralgia, and other epicranial headaches and Neuralgias: the epicranias
The Journal of Headache and Pain, 2003Co-Authors: Juan A. Pareja, Ja Pareja, Julio YangüelaAbstract:Nummular headache is characterized by mild to moderate, pressure-like head pain exclusively in a small, rounded or oval area without underlying structural lesions. Either during symptomatic periods or interictally, the affected area shows a variable combination of hypoesthesia, dysesthesia, paresthesia, tenderness or discomfort. The particular topography and signs of sensory dysfunction suggest that nummular headache is an extracranial headache probably stemming from epicranial tissues such as the terminal branches of sensory nerves. Apart from nummular headache, other headaches and Neuralgias such as idiopathic stabbing headache, trochleitis, supraorbital Neuralgia, external compression headache, nasociliary Neuralgia, occipital Neuralgias, and auriculotemporal Neuralgia have temporal or spatial features that suggest a peripheral (extracranial) origin, i. e. stemming from the bone, scalp, or pericranial nerves. Common to these disorders is a focal localization or a multidirectional sequence of paroxysms, paucity of accompaniments, tenderness on the emergence or course of a pericranial nerve or on the tissues where pain originates, and possible presence of symptoms and signs (including effective treatment with locally injected anesthetics or corticosteroids) of nerve dysfunction. These observations led to the emergence of a conceptual model of head pain with an epicranial origin that we propose to group under the appellation of epicranias (headaches and pericranial Neuralgias stemming from epicranial tissues). Nummular headache is the paradigm of epicranias. Epicranias essentially differ from other primary headaches with an intracranial origin and features of visceral pain, i. e. splanchnocranias that are characterized by a painful area wider than that of epicranias, no clear borders, presence of autonomic features, regional muscle tension, and driving of the process from the brain and brainstem.
Ahmet Sinav - One of the best experts on this subject based on the ideXlab platform.
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computed tomography guided trigeminal tractotomy nucleotomy in the management of vagoglossopharyngeal and geniculate Neuralgias
Neurosurgery, 1998Co-Authors: Yücel Kanpolat, Ali Savas, Funda Batay, Ahmet SinavAbstract:OBJECTIVE: Vagoglossopharyngeal and geniculate Neuralgias are less frequently seen types of cranial Neuralgias. Their causes and symptomatology are similar to those of trigeminal Neuralgia; however, the complex anatomic relationship between the intermedius, vagal, and glossopharyngeal nerves leads to difficulties in the diagnosis and management of Neuralgias originating from these cranial nerves. Numerous procedures have been used to treat intractable Neuralgias of the VIIth, IXth, and Xth cranial nerves: 1) extracranial sectioning of the cranial nerves, 2) percutaneous thermal rhizotomy, 3) intracranial glossopharyngeal and vagal rhizotomies, 4) microvascular decompression, and 5) percutaneous trigeminal tractotomy-nucleotomy (TR-NC) or nucleus caudalis dorsal root entry zone operation. We propose that computer-guided TR-NC may be the first-choice operation for patients with glossopharyngeal, vagal, or geniculate Neuralgia. PATIENTS AND METHODS: Nine patients suffering from idiopathic vagoglossopharyngeal Neuralgia (six patients) and geniculate Neuralgia (three patients) were managed at our clinic. Computed tomography-guided percutaneous trigeminal TR-NC was performed for these nine patients. RESULTS: Excellent (six patients) or good (three patients) pain control was obtained in each patient. Complications included temporary ataxia in two patients after TR-NC. CONCLUSION: The risk:benefit ratio should be evaluated individually to select the appropriate treatment procedure for patients with vagoglossopharyngeal and geniculate Neuralgias. Computed tomography-guided percutaneous TR-NC is an effective and minimally invasive procedure for such patients.
Atilla Halil Elhan - One of the best experts on this subject based on the ideXlab platform.
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computed tomography guided percutaneous trigeminal tractotomy nucleotomy
Neurosurgery, 2008Co-Authors: Yücel Kanpolat, Gokmen Kahilogullari, Hasan Caglar Ugur, Atilla Halil ElhanAbstract:OBJECTIVE: The destruction of the descending trigeminal tractus in the medulla is known as trigeminal tractotomy (TR), whereas the lesioning of the nucleus caudalis is known as trigeminal nucleotomy (NC). Trigeminal TR and/or NC procedures can be used in a large group of pain syndromes, such as glossopharyngeal, vagal, and geniculate Neuralgias, atypical facial pain, craniofacial cancer pain, postherpetic Neuralgias, and atypical forms of trigeminal Neuralgia. METHODS: In this study, anatomic and technical details of the procedure and the experience gained from 65 patients over the course of 20 years are discussed. Patients' pain scores and Karnofsky Performance Scale scores were evaluated pre- and postoperatively (postoperative Day 1). RESULTS: The best results were obtained in the second-largest group (vagoglossopharyngeal Neuralgia, n = 17) and in geniculate Neuralgia (n = 4). Patients with atypical facial pain (n = 21; 13 women, eight men) accounted for the largest group to undergo computed tomography-guided TR-NC surgery; pain relief was achieved in 19 of these patients. In the third-largest group (craniofacial and oral cancer pain, n = 13), 11 of 13 patients were successfully treated with TR-NC. Four of five patients with failed trigeminal Neuralgia were also effectively treated with TR-NC. CONCLUSION: We propose that computed tomography-guided TR-NC provides direct visualization of the target-electrode relation and can be considered a first-step procedure in patient management. In view of its high efficacy, low complication rate, and minimal invasiveness, computed tomography-guided trigeminal TR-NC is a safe and effective procedure in the treatment of intractable facial pain syndromes.
