RESUMEN
We report the use of an emergent, targeted fibrin spinal epidural blood patch with subarachnoid saline infusion to rapidly reverse "in-extremis" clinical and imaging signs of posterior-fossa coning brought about by acute-on-chronic intracranial hypotension, itself consequent to a cervicothoracic CSF leak. Treatment resulted in a dramatic recovery and eventual discharge with return to normal lifestyle and occupation. The clinical and imaging danger signs are reviewed; fibrin patch technique and potential pitfalls in postprocedure management are analyzed.
Asunto(s)
Parche de Sangre Epidural , Urgencias Médicas , Hipotensión Intracraneal/cirugía , Neuronavegación , Efusión Subdural/cirugía , Vértebras Cervicales/patología , Vértebras Cervicales/cirugía , Craneotomía , Diagnóstico Diferencial , Encefalocele/diagnóstico , Encefalocele/cirugía , Hematoma Subdural/diagnóstico , Hematoma Subdural/cirugía , Humanos , Aumento de la Imagen , Hipotensión Intracraneal/diagnóstico , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Mielografía , Examen Neurológico , Recurrencia , Reoperación , Efusión Subdural/diagnóstico , Vértebras Torácicas/patología , Vértebras Torácicas/cirugía , Tomografía Computarizada por Rayos XRESUMEN
AIMS: Trigeminal neuropathic pain is a broad diagnostic category that includes pain of several etiologies and excludes trigeminal neuralgia. The authors report a prospective series of percutaneous gasserian ganglion stimulation for trigeminal neuropathic pain. METHODS: Patients who experienced >50% reduction in pain from a 7- to 10-day trial period underwent permanent implantation and were prospectively followed. RESULTS: Eight of 10 trialed patients received a permanent implant. At the 12-month follow-up, 2 patients had been explanted and 1 was lost to follow-up. Three (all working at that the time) continued to experience >50% improvement in pain. DISCUSSION: The results in this series were variable but 3 patients showed long-term improvements. Patients who continued to work responded better to treatment.