[Neurosurgical treatment of pain].

INTRODUCTION: Surgical treatment of chronic pain includes destructive procedures (neurectomy, rhizotomy, sympathectomy), often referred to as ablative, and accompanied by high morbidity and mortality rates. SURGICAL TREATMENT OF PAIN: During the past three decades, thanks to current knowledge on chronic pain mechanisms and technological developments, such as improved microsurgical and stereotactic techniques, guided by computerized tomography, magnetic resonance imaging and neural tissue impendance monitoring, the majority of ablative procedures have been replaced by new methods. Among them, a few can be considered as selectively and minimally ablative (microsurgical spinothalamic cordotomy, dorsal root entry zone lesions, limited midline myelotomy) and others as neuroaugumentative procedures for neuromodulatory proceses (deep brain structures and spinal cord stimulation, drug-delivery systems). NEUROSURGICAL PROCEDURES: Cordotomy is very effective in pain treatment and it may produce complete abolishment of pain, especially in patients suffering from neoplastic invasion of the brachial plexus (Pancoast's syndrome) or lumbosacral plexus. Dorsal root entry zone operation is generally the only treatment option for pain due to root avulsion and segmental pain in spinal cord injury. Spinal cord stimulation is useful in management of pain following peripheral nerve injury. Deep brain stimulation is a promising treatment of central pain. CONCLUSION: The purpose of this review is to draw attention to neurosurgical approaches to treatment of chronic and opioid-resistant pain.

[Delayed epidural hematoma after mild head injury].

BACKGROUND: Traumatic delayed epidural hematoma (DEH) can be defined as insignificant or not seen on the initial CT scan performed after a trauma but seen on the subsequent CT scan as a "massive" epidural bleeding. CASE REPORT: We presented two cases of traumatic DEH after mild head injury. Both patients were conscious and without neurological deficit on the admission. Initial CT scan did not reveal intracranial hematoma. Repeated CT scan, that was performed after neurological deterioration, revealed epidural hematoma in both cases. The patients were operated with a favorable surgical outcome. CONCLUSION: Traumatic DEH could occur in the patients with head injuries who were conscious on the admission with a normal initial CT scan finding. Early detection of DEH and an urgent surgical evacuation were essential for a good outcome.