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
| Autor: | Piero Picozzi, Pierina Navarria, Concezione Tommasino, Luca Attuati, Antonella Stravato, Giovanni Colombo, Ismail Zaed, Enrico Massimo Arosio |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Conjunctival injection Conjunctiva Visual analogue scale medicine.medical_treatment Gamma knife radiosurgery Radiosurgery 03 medical and health sciences 0302 clinical medicine medicine Acupuncture Humans Trigeminal Nerve Trigeminal nerve SUNCT Syndrome business.industry Headache Middle Aged Magnetic Resonance Imaging Surgery Ganglion medicine.anatomical_structure Treatment Outcome 030220 oncology & carcinogenesis Neuralgia Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | World neurosurgery. 133 |
| ISSN: | 1878-8769 |
| Popis: | 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 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 the trigeminal nerve accompanied by inflammation of conjunctiva and involuntary lacrimation from 2006. During the following years, she received several treatments: combination of drugs, acupuncture, and endonasal infiltration of the sphenopalatine ganglion. The frequency of the painful attacks increased progressively and it was impossible for her to have a normal active life. Combined gamma knife radiosurgery treatment, targeting the trigeminal nerve (80 Gy maximum dose) and the sphenopalatine ganglion (80 Gy maximum dose) was performed in April 2016 (visual analog score 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 (visual analog score = 2) and has 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 noninvasive option to treat patients with medically refractory idiopathic SUNCT. |
| Databáze: | OpenAIRE |
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