Nucleus Caudalis DREZ Lesioning for Intractable Pain due to Invasive Sarcoma in Skull Base: Case Report

We present a case of nucleus caudalis DREZ operation for medically refractory facial pain due to invasive sarcoma in skull base. The patient showed excellent pain relief immediately after the operation. Until 5 month later, the pain was less than before surgery. At the point of view of pain characteristics and distribution, it was considered the trigemino-vago-glossopharyngeal neuralgia. It is suggested that the nucleus caudalis DREZ operation is effective in treating medically refractory facial pain due to invasive sarcoma in skull base.

Pain Relief from Dorsal Root Entry Zone(DREZ) Lesions Made with CO2 Laser in Brachial Plexus Injury Patients

Treatment of pain related to various types of deafferentation remains a neurosurgical challenge. Medical therapy and conventional surgical techniques for pain relief have not been effective due to this problem. Six patients with intractable pain following a brachial plexus injury were treated with dorsal root entry zone(DREZ) lesions. These lesions were made with CO2 laser. All patients were followed from 5 months to 5 years after surgery. Two-third of the patients were relieved of more than 50% of their preoperative pain. Post-operative neurosurgical complications were ipsilateral leg weakness and loss of proprioception in 2 cases. The laser technique is exact, makes uniform lesion, shortens the duration of the procedure, lessens cord manipulation and makes shalow penetration into the surrounding spinal cord. Dorsal root entry zone(DREZ) lesions made with CO2 laser appeared to be a satisfactory treatment for brachial plexus injury patients who have failed to respond to more conservative modes of therapy.