Thalamic deep brain stimulation for post-traumatic neuropathic limb pain: Efficacy at five years' follow-up and effective volume of activated brain tissue.

Chronic neuropathic pain affects 7%-10% of the population. Deep brain stimulation (DBS) has shown variable but promising results in its treatment. This study prospectively assessed the long-term effectiveness of DBS in a series of patients with chronic neuropathic pain, correlating clinical results with neuroimaging. Sixteen patients received 5 years' post-surgical follow-up in a single center. Six had phantom limb pain after amputation and 10 had deafferentation pain after traumatic brachial plexus injury. Patient-reported outcome measures were completed before and after surgery, using VAS, UWNPS, BPI and SF-36 scores. Neuroimaging evaluated electrode location and effective volumes of activated tissue (VAT). Two subgroups were created based on the percentage of VAT superimposed upon the ventroposterolateral thalamic nucleus (eVAT), and clinical outcomes were compared. Analgesic effect was assessed at 5 years and compared to preoperative pain, with an improvement on VAS of 76.4% (p=0.0001), on UW-NPS of 35.2% (p=0.3582), on BPI of 65.1% (p=0.0505) and on SF-36 of 5% (p=0.7406). Eight patients with higher eVAT showed improvement on VAS of 67.5% (p=0.0017) while the remaining patients, with lower eVAT, improved by 50.6% (p=0.03607). DBS remained effective in improving chronic neuropathic pain after 5 years. While VPL-targeting contributes to success, analgesia is also obtained by stimulating surrounding posterior ventrobasal thalamic structures and related spinothalamocortical tracts.

[Cavernous malformation of the pineal region. Case report and review of the literature]. / Malformación cavernosa de la región pineal. Caso clínico y revisión de la literatura.

Cavernous malformations rarely occur in the pineal region with only 21 reported to date. Although its diagnosis is not easy because of the extreme rareness of this condition, the presence of this lesion can be suspected based on its typical radiological findings. We report the case of a 57-year-old woman presented with desorientation, somnolence and diplopy. The CT-scan showed an acute hemorrhage in the pineal region and triventricular hydrocephalus. An MRI suggested a cavernous malformation. The patient was operated with total en-bloc removal of the lesion. We conclude that surgical exploration and total resection is the treatment of choice when the diagnosis of cavernous angioma is suspected of the basis of neuroimaging.

Malformación cavernosa de la región pineal. Caso clínico y revisión de la literatura / Cavernous malformation of the pineal region. Case report and review of the literature

Las malformaciones cavernosas de la región pinealson raras, con solamente 21 casos publicados hasta elmomento en la literatura. A pesar de la dificultad de sudiagnóstico debido a su extrema rareza, la presenciade esta lesión puede ser sospechada basándonos en suscaracterísticas radiológicas.Presentamos el caso de una paciente de 57 años deedad, con un cuadro clínico de instauración aguda dedesorientación, somnolencia y diplopia. La TC cerebralmostró una hemorragia aguda en la región pineal ehidrocefalia triventricular asociada y la RM cerebralfue sugestiva de que se tratase de una malformacióncavernosa. La paciente fue operada con escisión totalde la lesión y el estudio histológico confirmó el diagnósticode angioma cavernoso. Concluimos que la cirugíapara extracción total de la lesión es el tratamiento deelección cuando, basados en la imagen, sospechamos unangioma cavernoso de la región pineal (AU)

Cavernous malformations rarely occur in the pinealregion with only 21 reported to date. Although its diagnosisis not easy because of the extreme rareness of thiscondition, the presence of this lesion can be suspectedbased on its typical radiological findings.We report the case of a 57-year-old woman presentedwith desorientation, somnolence and diplopy.The CT-scan showed an acute hemorrhage in thepineal region and triventricular hydrocephalus.An MRI suggested a cavernous malformation. Thepatient was operated with total en-bloc removal of thelesion. We conclude that surgical exploration and totalresection is the treatment of choice when the diagnosisof cavernous angioma is suspected of the basis of neuroimaging (AU)

[Trigeminal neuralgia caused by contra lateral cerebellopontine angle tumor. A case report]. / Neuralgia del trigémino provocada por un tumor del ángulo ponto-cerebeloso contralateral. Caso clínico.

In most cases, trigeminal neuralgia is due to compression of the trigeminal nerve in the zone of entrance at the pons by vascular structures. About 1% of cases, have trigeminal neuralgia associated with the presence of ipsilateral lesion of cerebellar-pontine angle. Rarely, trigeminal neuralgia may be due to contralateral posterior fossa tumors. We present a case of a 37-year- old patient who presented with right trigeminal neuralgia and harboured a left acoustic neuroma of significant dimension. Facial pain completely disappeared after tumor removal.

Neuralgia del trigémino provocada por un tumor del ángulo ponto-cerebelosocontralateral. Caso clínico / Trigeminal neuralgia caused by contra lateral cerebellopontine angle tumor. A case report

La gran mayoría de neuralgias del trigémino sonatribuidas a la compresión por estructuras vasculares,de la zona de entrada del nervio a nivel de la protuberancia.En torno al 1% de los casos de neuralgia deltrigémino están asociados a tumores del ángulo pontocerebelosoipsilaterales. Las neuralgias del trigéminoprovocadas por tumores contralaterales de la fosaposterior son muy raras. Los autores presentan el casoclínico de un paciente de 37 años, con una neuralgiadel trigémino derecha y un voluminoso neurinoma delacústico izquierdo. El dolor remitió completamente despuésde la escisión del tumor (AU)

In most cases, trigeminal neuralgia is due to compressionof the trigeminal nerve in the zone of entranceat the pons by vascular structures. About 1% of cases,have trigeminal neuralgia associated with the presenceof ipsilateral lesion of cerebellar-pontine angle. Rarely,trigeminal neuralgia may be due to contralateral posteriorfossa tumors. We present a case of a 37-year- oldpatient who presented with right trigeminal neuralgiaand harboured a left acoustic neuroma of significantdimension. Facial pain completely disappeared aftertumor removal (AU)

Foraminal L5-S1 disc herniation and conus medullaris syndrome: a vascular etiology?

A 56-year-old man presented with a conus medullaris syndrome lumbar magnetic resonance imaging showed only a right foraminal disc herniation at the L5-S1 level. Operative removal of the protrusion was followed by prompt neurological improvement. We postulate that the discrepancy between extent of compression shown by imaging and the neurological findings may reflect vascular compression of the artery of Desproges-Gotteron, an anatomical variant.