[Sphenopalatine ganglion stimulation in the treatment of chronic refractory cluster headache. A preliminary multicenter study in Russia]. / Stimulyatsiya krylonebnogo gangliya v lechenii khronicheskoi klasternoi golovnoi boli. Rezul'taty pervogo mul'titsentrovogo opyta v Rossii.

OBJECTIVE: To analyze the results of sphenopalatine ganglion stimulation in treatment of chronic headache. MATERIALS AND METHODS: Medical histories of patients who underwent sphenopalatine ganglion stimulation in 4 clinical centers have been analyzed. The analysis included the type of pain and its characteristics, methods of surgery, CT, MRI, radiography before and after surgery. The follow-up data of patients with implanted pulse generators was collected in an outpatient clinic or by telephone review. RESULTS: The study included 15 patients with chronic refractory headache, including 14 with cluster headache and one female patient with features of trigeminal autonomic cephalgia without a clear definition of the type of pain. Trial stimulation was performed in 10 patients to determine analgesic effect. Among them stimulation was favorable in 7 cases, and 6 of them underwent pulse generator implantation. In total, 11 (73%) patients underwent implantation with a follow-up from 1 to 60 months. Among them only 6 (54%) patients use stimulation, the remaining 5 (46%) cases had device-related complications (migration, infection of system). Cluster headache has a significant improvement in long-term follow-up. CONCLUSIONS: Sphenopalatine ganglion stimulation may have high potential in the treatment of chronic drug-resistant cluster headache. The complication rate demonstrates that operative technique should be improved.

[Stereotactic radiosurgery in treatment of trigeminal neuralgia]. / Stereotaksicheskaia radiokhirurgiia v lechenii trigeminal'noi nevralgii.

It was not until relatively recently that the method of stereotactic radiosurgery has started to be used for treating trigeminal neuralgia. Being minimally invasive, this method can be considered an attractive alternative to invasive surgical methods. OBJECTIVE: The objective of this study was to analyze the results of treatment in patients with trigeminal neuralgia using the Leksell Gamma Knife system. MATERIAL AND METHODS: The results of stereotactic radiosurgery were analyzed in 52 patients (31 females and 21 males aged 31 to 79 years) who had undergone treatment at the Radiosurgical Center of MIBS (St. Petersburg) in 2009-2016. Forty-four patients were diagnosed with typical trigeminal neuralgia; four patients, with atypical neuralgia; and four patients, with symptomatic neuralgia (accompanying multiple sclerosis). Pain severity was assessed using the Visual Analogue Scale (VAS) and the Barrow Neurological Institute Scale (BNIPS) before and after the surgery, as well as during the follow-up period (mean duration, 3 years). RESULTS: Pain was reduced in 38 (86.4%) patients with type 1 neuralgia. The effect usually was not observed immediately after the surgery but was delayed from several weeks to 12 months (median, 2 months; interquartile range) [1, 4]. The surgery was ineffective in 6 (14%) patients. Eight (18%) patients had a relapse on average after 2 years and 5 months. By the end of the follow-up period, score I according to the BNIPS was achieved in 22 (50%) patients; score II or III was achieved in 7 (16%) patients. Primary reduction of pain was achieved in two patients with type 2 neuralgia; one of them had a relapse after 19 months. Among patients with symptomatic neuralgia, the primary effect was achieved in three patients, but two of them later had a relapse. CONCLUSION: Stereotactic radiosurgery can be used to alleviate pain in most patients with type 1 trigeminal neuralgia, but its results are inferior to those of invasive interventions. According to our findings, 18% of patients had a relapse. For patients with multiple sclerosis accompanied by type 2 and symptomatic trigeminal neuralgia, this method is not sufficiently effective. When both microvascular decompression and stereotactic radiosurgery can be used to treat for type 1 and 2 trigeminal neuralgia, patient's choice is crucial. It is important to inform the patient both about the potential complications of the interventions and about the delayed effect of the surgery and relapse frequency.

[Motor cortex stimulation in deafferentation facial pain]. / Stimuliatsiia motornoi kory pri deafferentatsionnoi litsevoi boli.

OBJECTIVE: To demonstrate the results of treatment of poorly controlled deafferentation facial pain using motor cortex stimulation and to review the relevant literature. MATERIAL AND METHODS: The study included 8 patients (3 males and 5 females) with deafferentation facial pain who were implanted with a system of constant motor cortex stimulation at the Illinois University in Chicago in 2004-2016 and Novosibirsk Federal Center of Neurosurgery in 2017. The patients' age ranged from 37 to 81 years (mean age, 57.5 years). Scale-based assessment of the pain severity was performed at admission to hospital, at discharge, and during follow-up. The visual analogue pain scale, Barrow Neurological Institute pain scale (BNIPS), and McLaughlin scale were used. RESULTS: Immediately after surgery, a significant improvement in the form of pain reduction by 80-100% occurred in 4 patients. The pain intensity at discharge from the hospital decreased by 55%, on average. During the follow-up period, the efficacy of motor cortex stimulation was assessed (McLaughlin scale) as very good by 3 of the 8 patients, as good by 4 patients, and as unsatisfactory by 1 patient. CONCLUSION: Our findings and recent studies have demonstrated that motor cortex stimulation is one of the treatment options for deafferentation facial pain. Even a slight decrease in the intensity of excruciating and debilitating pain (assessed by patients as a good effect) gives grounds for application of the procedure. Further research is needed to define more precise criteria for selecting patients for this treatment and to increase the efficacy of stimulation.

[Evaluation of short-term surgical outcomes in facial paralysis patients treated by trigeminal neurotization]. / Otsenka blizhaishikh rezul'tatov khirurgicheskogo lecheniya bol'nykh s litsevym paralichom metodom trigeminal'noi nevrotizatsii.

UNLABELLED: The management of patients with facial nerve palsy is a challenge of modern neurosurgery. The study purpose was to evaluate the degree of facial nerve function recovery, following trigeminal neurotization. Trigeminal neurotization was performed in 23 patients within 1 to 10 months after the development of facial paralysis. In most cases, the cause of facial paralysis was surgery for space-occupying lesions of the cerebellopontine angle (95.6%). Outcomes of trigeminal neurotization were evaluated in 17 (73.9%) patients who were followed-up for more than 6 months. In 16 (94.1%) patients, the facial nerve function was recovered to a House-Brackmann grade III-IV. Given the surgery RESULTS: we can say that trigeminal neurotization is one of the effective treatments for facial paralysis. In most cases, this technique has provided good outcomes without additional complications, which is important for this group of patients.

[Teflon granuloma after microvascular decompression of the trigeminal nerve root in a patient with recurrent trigeminal neuralgia].

The use of a Teflon implant for Jannetta surgery in patients with trigeminal neuralgia is complicated in rare cases by the development of a Teflon granuloma and can cause recurrent facial pain. The article presents a clinical case of a Teflon granuloma developed after microvascular decompression of the trigeminal nerve root, describes the surgical findings and histological picture, and analyzes the literature, causes of granuloma development, and recommendations for treatment of these patients.

[The use of frameless navigation during endoscopic interventions in children with multilocular hydrocephalus].

INTRODUCTION: The use of the endoscopic technique largely improves treatment outcomes in patients with multilocular hydrocephalus. However, impaired anatomy and the lack of usual landmarks often cause problems in planning and intraoperative identification of changed structures. The use of frameless navigation during endoscopic interventions can significantly facilitate surgeon tasks and increases the efficacy of surgery. During surgery, the neuronavigation system visualizes a rigid endoscope that interconnects separated ventricles and cysts. Surgery can be completed with guiding a stent through an operating channel of the endoscope and implanting a shunt system. MATERIAL AND METHODS: Ten children underwent 11 endoscopic interventions using frameless intraoperative navigation at our clinic in 2013-2014. The number of surgically interconnected compartments ranged from 3 to 5. Simultaneous placement of a shunt system was performed in 8 of 11 interventions. RESULTS: Clinical improvement as a result of the operation was achieved in all children. 2 patients underwent re-operations 5 months and 1 year after endoscopic intervention. CONCLUSION: Thus, the use of frameless navigation during endoscopic interventions makes their implementation most efficient and safe for the patient.