Cases reported "Neuralgia"

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1/22. Endoscopic supraorbital nerve neurolysis.

    Endoscopic surgery, performed through small incisions, yields therapeutic results equivalent or superior to those obtained using the conventional approach. The technique has been established in laparoscopic cholecystectomic surgery. In plastic surgery, endoscopic techniques were first developed in aesthetic procedures and have been reported to be useful in face-lift operations, breast reconstruction, muscle flap harvesting and subcutaneous surgery. Endobrow lift has become a more and more popular aesthetic procedure. The endoscope provides an excellent magnification and, through a high power light source, a very good illumination of the operative field. It explains why the endoscope is more and more used in reconstructive procedures. We report the case of a patient suffering from a posttraumatic entrapment of the right supraorbital nerve which was released by an endoscopic approach.
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2/22. Neurogenic pain.

    Effective preoperative communication and an awareness of the mechanisms and treatment of neurogenic pain by nursing staff directly influence the choice of intraoperative and postoperative pain management. This article describes the case study of a young woman with neurogenic pain and highlights the importance of having a working knowledge of this type of pain, its assessment, and treatment.
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3/22. Use of endoscopic transthoracic sympathicotomy in intractable postherpetic neuralgia of the chest.

    Although there are various treatments for postherpetic neuralgia (PHN), none produces definitive effects. We report a case of 72-year-old woman who developed intractable PHN of the chest in which treatment with endoscopic transthoracic sympathicotomy (ETS) produced long-term effective results. When hyperesthesia of the sympathetic nerve participates in PHN, the blocking of sympathetic excitation seems to be effective for PHN suppression. The method using a single resectoscope is safe, accurate, yields excellent results cosmetically, and generates minimal invasion and very little postoperative pain. Although ETS is not always effective for all cases of PHN, it could be a useful method of treating patients with PHN that is resistant to conventional therapies.
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4/22. Surgical treatment of trigeminal neuralgia.

    trigeminal neuralgia, which is unilateral electric shock or knifelike pain occurring in one or more branches of the trigeminal nerve, is evoked by stimulation of the face, lips, or gums caused by activities such as shaving, brushing the teeth, or moving trigger zones. IT GENERALLY IS ACCEPTED that classic trigeminal neuralgia is a consequence of vascular compression and demyelination of the trigeminal nerve. Although medical therapy is available, it gradually becomes less effective because of the progressive nature of trigeminal neuralgia. MICROVASCULAR decompression of the trigeminal nerve to treat trigeminal neuralgia is discussed in this article. perioperative care, expected course of recovery, and potential complications are described.
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5/22. Bilateral glossopharyngeal neuralgia after excision of a solitary cervico-medullary haemangioblastoma: case report.

    A man presenting with sleep apnoea was found to have a haemangioblastoma at the cervico-medullary junction. The associated hydrocephalus and syringomyelia resolved after excision of the tumour. Postoperatively the patient developed transient bilateral glossopharyngeal neuralgia, presumably due to surgical damages to the tractus solitarius. To the best of our knowledge this is the first reported case with transient bilateral glossopharyngeal neuralgia following resection of a haemangioblastoma of the cervico-medullary junction.
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6/22. Ventrolateral partial dorsal root entry zone rhizotomy for occipital neuralgia.

    OBJECTIVE AND IMPORTANCE: Medically refractory occipital neuralgia (ON) has been treated with a variety of neuroablative procedures. The present case report supports the effectiveness of ventrolateral partial rhizotomy (pVL-DREZ) of the C1 to C3 cervical dorsal roots, a relatively unknown procedure. CLINICAL PRESENTATION: A 46-year-old woman had a 14-month history of severe right-sided ON. Multiple trials of medical treatments, nerve blocks and local steroid injections had failed. Her daily opioid requirements had escalated to include frequent injections in addition to prescribed oral opiates. INTERVENTION AND RESULTS: A pVL-DREZ at the right C1 to C3 level was performed through a C1 laminectomy and C2 right laminotomy. The ipsilateral upper cervical dorsal roots were exposed and a 1 mm deep incision was made at a 45 degrees angle to the sagittal midline at the ventrolateral aspect of each dorsal rootlet entry. The patient experienced postoperative opioid withdrawal seizure and transient disequilibrium for two weeks. touch sensation was preserved and complete abolition of ON over a four year follow-up was achieved. CONCLUSION: The pVL-DREZ procedure provided complete pain relief for the patient and avoided the potential complications often encountered with other destructive interventions. pVL-DREZ should be considered among the available options for the treatment of refractory ON.
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7/22. Two cases of spinal epidural abscess with granulation tissue associated with epidural catheterization.

    Two cases of spinal epidural abscess are reported whose abscesses became granulated after epidural catheterization. Although emergency surgical intervention was performed almost within 24 h after the diagnosis of epidural abscess in case 1, the patient revealed a poor outcome. After laminoplasty, case 2 received lumbar epidural catheterization, and he had a complete recovery. The abscesses were recognized to spread around the catheter insertion site of the operative procedure in both cases, and MRI in case 2 showed the connection between the epidural abscess and the interspinous space where the catheter had been inserted. methicillin-sensitive staphylococcus aureus (MSSA) was identified at the operative field in both cases. Also, MSSA was identified at the subcutaneous abscess around the catheter in case 1 and at the catheter tip in case 2. Those findings suggest the midpoint of the abscess is the puncture site and that MSSA is found in or around the catheter. infection at epidural catheterization seems to be caused by catheter insertion or skin contamination after catheterization. As those catheterizations were completed in the outpatient theater, we conclude that epidural catheterization should be performed in the operating room or with a restricted aseptic technique.
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8/22. T2-ganglionectomy via limited costotransversectomy for minor causalgia.

    T2-ganglionectomy via limited costotransversectomy is a safe and effective method to produce sympathetic denervation of the upper extremity. It provides prompt and lasting relief of the complex array of symptoms associated with minor causalgia. Four patients with minor causalgia treated by this procedure are presented. All patients were seen by multiple physicians before a correct diagnosis was made. Pain and trophic changes resolved in all cases. No instances of Horner's syndrome or pneumothorax were encountered. Preoperative response to temporary stellate ganglion block is essential to both diagnosis and treatment. Consideration of early surgical intervention should be given in cases involving significant disability. A fundamental problem surrounding the appropriate management of minor causalgia has been and continues to be accurate recognition of the diagnosis.
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9/22. Glossopharyngeal neuralgia with syncope and cervical mass.

    GPN syndrome with syncope, hypotension, and bradycardia is rare. The association of this syndrome with neck masses mandates that these patients undergo a search for such tumors. A review of the literature and our experience revealed 12 cases of this syndrome associated with neck masses. The majority (60%) of the patients did not respond to medical therapy and eventually required a neurosurgical procedure to cure symptoms. However, medical therapy, including high-dose carbamazepine, should be tried first, particularly in individuals who represent a high operative risk.
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10/22. Concerning the management of pain associated with herpes zoster and of postherpetic neuralgia.

    This simple method of achieving substantial pain control in patients with documented herpes zoster and postherpetic neuralgia has been effective in each of the patients in whom it has been used (the most recent 12 cases have been summarized for this report). It has been more effective than narcotic analgesics, oral anti-inflammatory analgesics, sedatives, tranquilizers, TENS, hypnosis and the wide variety of operative measures we have tried in the past. Although it was initially used pragmatically, there is now a reasonable rationale for its effectiveness that can be proposed based on more recent insights into the anatomy and neurophysiology of cutaneous nociceptors and the neuropharmacology of aspirin. In view of the widely held persuasion that the management of pain syndromes associated with herpes zoster (especially severe postherpetic neuralgia) is an unsatisfactory and frustrating venture, it seemed reasonable to report these more favorable clinical observations.
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