Neurectomy of C2 for the Treatment of Occipital Neuralgia: Case Report

Occipital neuralgia (ON) is an uncommon cause of headache, and it is characterized by a stabbing paroxysmal pain that radiates to the occipital region. The present study includes a review of the literature and a case report. The etiology of this pathology can vary from traumas, infections, compressions of nerves or vertebrae, skull base surgeries, to degenerative changes and congenital anomalies. However, most of the time, the etiology is considered idiopathic. The diagnosis is essentially clinical. However, it is crucial that other types of primary headache are excluded. The treatment for ON may be based on nerve blocks, medications or surgeries. Neurectomy of the second spinal nerve is among the surgical techniques available.

Protective Effects of Gabapentin on Allodynia and alpha2delta1-Subunit of Voltage-dependent Calcium Channel in Spinal Nerve-Ligated Rats

This study was designed to determine whether early gabapentin treatment has a protective analgesic effect on neuropathic pain and compared its effect to the late treatment in a rat neuropathic model, and as the potential mechanism of protective action, the alpha2delta1-subunit of the voltage-dependent calcium channel (alpha2delta1-subunit) was evaluated in both sides of the L5 dorsal root ganglia (DRG). Neuropathic pain was induced in male Sprague-Dawley rats by a surgical ligation of left L5 nerve. For the early treatment group, rats were injected with gabapentin (100 mg/kg) intraperitoneally 15 min prior to surgery and then every 24 hr during postoperative day (POD) 1-4. For the late treatment group, the same dose of gabapentin was injected every 24 hr during POD 8-12. For the control group, L5 nerve was ligated but no gabapentin was administered. In the early treatment group, the development of allodynia was delayed up to POD 10, whereas allodynia was developed on POD 2 in the control and the late treatment group (p<0.05). The alpha2delta1-subunit was up-regulated in all groups, however, there was no difference in the level of the alpha2delta1-subunit among the three groups. These results suggest that early treatment with gabapentin offers some protection against neuropathic pain but it is unlikely that this action is mediated through modulation of the alpha2delta1-subunit in DRG.

Clinical Efficacy of Radiofrequency Cervical Zygapophyseal Neurotomy in Patients with Chronic Cervicogenic Headache

The purpose of the present study was to assess the clinical efficacy of radiofrequency (RF) cervical zygapophyseal joint neurotomy in patients with cervicogenic headache. A total of thirty consecutive patients suffering from chronic cervicogenic headaches for longer than 6 months and showing a pain relief by greater than 50% from diagnostic/prognostic blocks were included in the study. These patients were treated with RF neurotomy of the cervical zygapophyseal joints and were subsequently assessed at 1 week, 1 month, 6 months, and at 12 months following the treatment. The results of this study showed that RF neurotomy of the cervical zygapophyseal joints significantly reduced the headache severity in 22 patients (73.3%) at 12 months after the treatment. In conclusion, RF cervical zygapophyseal joint neurotomy has shown to provide substantial pain relief in patients with chronic cervicogenic headache when carefully selected.

Neurorrafia do nervo espinal acessorio apos esvaziamento cervical radical para reabilitacao funcional do ombro / Post radical neck dissection spinal acessory nerve grafting for shoulder functional rehabilitation

O esvaziamento cervical radical e de indicaçao frequente na indicaçao terapeutica do cancer da cabeça e pescoço. A dor, disfunçao e quedado ombro sao as principais consequencias desse tratamento e apresentam importante papel na reintegraçao social e ocupacional dos pacientes. De fevereiro del980 a abril de l987 no Serviço de Cabeça e Pescoço do Hospital Heliopolis- SaoPaulo, foram realizados 91 esvaziamentos cervicais radicais modificados pela dissecçao,secçao e sutura do nervo espinal,com intuito de minimizar os efeitos resultantes da disfunçao da musculatura da cintura escapular.Sao apresentados atecnica utilizada e os resultados quanto a reinervaçao do musculo trapezio,que atinge de 50% a 80% da funçao normal(71%dos casos) em intervalos variaveis de tempo entre 3 e 12 meses.Trata-se de uma intervençao que nao prejudica o tempo operatorio e que,principalmente,nao compromete a radicalidade, podendo ser considerada em serviços nao especializados e naqueles que eventualmente tratam de pacientes portadores de cancer da regiao cervico-facial.