Comparison of Percutaneous Retrogasserian Balloon Compression and Gamma Knife Radiosurgery for the Treatment of Trigeminal Neuralgia in Multiple Sclerosis.

OBJECTIVE: We compared and evaluated percutaneous retrogasserian balloon compression (PBC) and Gamma Knife radiosurgery (GKRS) for treatment of trigeminal neuralgia (TN) in patients with multiple sclerosis (MS). METHODS: In this single-center, retrospective comparative study, 202 patients with MS and concomitant TN were evaluated. A minimum follow-up of 24 months was required. Patients with a history of microvascular decompression or previous intervention were excluded. Between February 2009 and December 2013, 78 PBC procedures and 124 first-dosage GKRS procedures were performed. PBC procedures were successfully completed in all cases. The 2 groups were compared with regard to initial effect, duration of effect, and complications including type and severity. RESULTS: Immediate pain relief occurred in 87% of patients treated with PBC and in 23% of patients treated with GKRS. Kaplan-Meier plots for the 2 treatment modalities were similar. The 50% recurrence rate was at 12 months for the PBC group and 18 months for the GKRS group. Complication (excluding numbness) rates were 3% for GKRS and 21% for PBC. The difference was statistically significant (χ2 test, P = 0.03). CONCLUSIONS: PBC and GKRS are effective techniques for treatment of TN in patients with MS. Fewer complications and superior long-term relief were associated with GKRS. We consider GKRS as the first option for the treatment of TN in patients with MS, reserving PBC for patients with acute, intractable pain.

A case report and technical tip of chronic subdural hematoma treated by the placement of a subdural peritoneal shunt.

BACKGROUND: Chronic subdural hematomas (CSDH) tend to occur most commonly in the elderly population, usually resulting from minor or insignificant head trauma. The pathophysiology behind CSDH is often directly associated with cerebral atrophy, and other causes of cerebral atrophy such as alcoholism or dementia. Other predisposing factors include diabetes, coagulopathy, use of anticoagulants (including aspirin), seizure disorders, and CSF shunts. Considerable evidence supporting the use of external drainage after evacuation of primary CSDH is readily available in the literature. CASE REPORT: We report the case of a 72 year-old male with a history of recurrent left subdural hematoma presenting to the neurosurgical clinic with a two-day history of personality changes, difficulty speaking, urinary incontinence, and headaches. Burr hole evacuation was performed with the placement of a subdural peritoneal shunt. At the one-month follow-up appointment, the patient had complete resolution of symptoms and CT scan showed no new recurrence of the subdural hematoma. CONCLUSIONS: Although several treatment options are available for the management of CSDH, recurrence of hematoma is a major and very common complication that may result in re-injury due to mass effect caused by chronic hematoma. However, placement of subdural peritoneal shunt for the treatment of CSDH can reduce the recurrence rate of CSDH and therefore, reduce the risk of brain re-injury.