Percutaneous Balloon Compression for Trigeminal Neuralgia: Imaging and Technical Aspects.

Trigeminal neuralgia attacks are among the most painful conditions known. Trigeminal neuralgias are hypothesized to be caused by neurovascular conflict at the trigeminal root entry zone in the prepontine cistern. A range of therapeutic options is available including open surgical microvascular decompression and several percutaneous ablative techniques (eg, radiofrequency rhizotomy and glycerol gangliolysis). Percutaneous balloon compression of the Gasserian retroganglionic rootlets has been reported to have results comparable to those of other minimally invasive techniques. This operative approach has proven popular with neurosurgeons as it is considered to be technically easier to perform than other methods. Nevertheless, pain physicians might regard this technique as challenging, relatively risky, and requiring special expertise. Accordingly, in this imaging article, we describe our percutaneous balloon compression procedure, paying particular attention to the technical and radiological details.

Estimulación del nervio occipital para la cefalea en racimos refractaria al tratamiento farmacológico / Stimulation of the occipital nerve in the treatment of drug-resistant cluster headache

Objetivo. Evaluar la utilidad de la estimulación del nervio occipital en el tratamiento de la cefalea en racimos crónica refractaria al tratamiento farmacológico. Pacientes y métodos. Serie prospectiva de cuatro pacientes, tres varones y una mujer. La edad media es de 42 años. Hay historia de cefalea en racimos de entre 1 y 16 años, con mal control de las crisis mediante tratamiento farmacológico. En todos los casos se han colocado percutáneamente electrodos octopolares en ambas regiones occipitales. Se ha realizado un seguimiento de seis meses. Resultados. A los seis meses se obtuvo una reducción de la frecuencia de las crisis del 56% (rango: 25-95%), una disminución en la intensidad del 48,8% (rango: 20-60%) y una disminución de la duración de un 63,8% (rango: 0-88,8%), sin observarse empeoramiento ni progresión de la enfermedad en ningún caso. La mejoría en la calidad de vida respecto a la prequirúrgica fue de un 15,4% (rango: 6-31,5%) en el cuestionario de salud SF-36. Excepto en un caso, se objetivó una reducción significativa en la cantidad y la dosis de fármacos requeridos respecto al tratamiento prequirúrgico. No se han detectado complicaciones postoperatorias. Todos los pacientes aconsejarían el procedimiento como opción terapéutica. Conclusiones. La estimulación del nervio occipital puede ser una alternativa terapéutica segura y efectiva en el tratamiento de la cefalea en racimos crónica refractaria al tratamiento farmacológico. Sin embargo, son necesarios más estudios para valorar la efectividad de la técnica en un mayor número de pacientes y los resultados a largo plazo (AU)

Aim. To evaluate the occipital nerve stimulation therapy in as a treatment for drug-resistant cluster headache. Patients and methods. Prospective study of four patients, three males and one female. Mean age of 42 years. Patients complained of a cluster headache lasting between one and 16 years, with suboptimal control of the attacks with medication. In all cases octopolar electrodes were placed percutaneously in the occipital region bilaterally. Follow-up of 6 months. Results. At 6 months, there was a 56% (range: 25-95%) reduction in the frequency, a 48.8% (range: 20-60%) decrease in the intensity and a 63.8% (range: 0-88.8%) reduction in the duration of the attacks. Worsening or progression of the illness was not observed in any case. All patients referred a 15.4% (range: 6-31.5%) improvement in their quality of life compared to their previous basal situation in SF-36. In all cases but one there was a significant reduction in the amount and dosage of medication required. Postoperative complications were not observed. All patients would recommend the procedure. Conclusions. Occipital nerve stimulation may be considered a safe and effective therapeutic option in the drug-resistant cluster headache. However, studies with more patients and a longer follow-up are required to evaluate the efficacy of the technique (AU)

[Stimulation of the occipital nerve in the treatment of drug-resistant cluster headache]. / Estimulación del nervio occipital para la cefalea en racimos refractaria al tratamiento farmacológico.

AIM: To evaluate the occipital nerve stimulation therapy in as a treatment for drug-resistant cluster headache. PATIENTS AND METHODS: Prospective study of four patients, three males and one female. Mean age of 42 years. Patients complained of a cluster headache lasting between one and 16 years, with suboptimal control of the attacks with medication. In all cases octopolar electrodes were placed percutaneously in the occipital region bilaterally. Follow-up of 6 months. RESULTS: At 6 months, there was a 56% (range: 25-95%) reduction in the frequency, a 48.8% (range: 20-60%) decrease in the intensity and a 63.8% (range: 0-88.8%) reduction in the duration of the attacks. Worsening or progression of the illness was not observed in any case. All patients referred a 15.4% (range: 6-31.5%) improvement in their quality of life compared to their previous basal situation in SF-36. In all cases but one there was a significant reduction in the amount and dosage of medication required. Postoperative complications were not observed. All patients would recommend the procedure. CONCLUSIONS: Occipital nerve stimulation may be considered a safe and effective therapeutic option in the drug-resistant cluster headache. However, studies with more patients and a longer follow-up are required to evaluate the efficacy of the technique.

Cordoma sacrococcígeo. Abordaje por vía posterior / No disponible

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Bilateral anterior capsulotomy for refractory obsessive-compulsive disorders.

A prospective study on the effects of bilateral anterior capsulotomy in patients with refractory obsessive-compulsive disorder (OCD) is presented. A total of 18 procedures were performed in 15 patients. The mean duration of the OCDs was 18.1 +/- 5.6 years (range 11-26 years). The mean total Yale-Brown Scale (Y-BOCS) score was 29.67 and mean Global Assessment of Functioning was 43.61. The results throughout the follow-up period remained the same as at 1 month postoperatively. The observed mean recovery on the Y-BOCS was 33.2% (p = 0.017). 52.9% of the patients showed a 33% recovery, 29.4% of the cases showed a 50% recovery and 17% showed a 66% recovery. Global Assessment of Functioning recovered by 19% (p = 0.111). No cognitive deficit was disclosed by neuropsychological screening tests. Complications were observed in 3 cases, 1 with transitory hallucinations, 1 with a single epileptic seizure and 1 case who developed a progressive behavior disorder that became permanent. We conclude that bilateral anterior capsulotomy is a safe and effective procedure.