RESUMO
We report the use of an emergent, targeted fibrin spinal epidural blood patch with subarachnoid saline infusion to rapidly reverse "in-extremis" clinical and imaging signs of posterior-fossa coning brought about by acute-on-chronic intracranial hypotension, itself consequent to a cervicothoracic CSF leak. Treatment resulted in a dramatic recovery and eventual discharge with return to normal lifestyle and occupation. The clinical and imaging danger signs are reviewed; fibrin patch technique and potential pitfalls in postprocedure management are analyzed.
Assuntos
Placa de Sangue Epidural , Emergências , Hipotensão Intracraniana/cirurgia , Neuronavegação , Derrame Subdural/cirurgia , Vértebras Cervicais/patologia , Vértebras Cervicais/cirurgia , Craniotomia , Diagnóstico Diferencial , Encefalocele/diagnóstico , Encefalocele/cirurgia , Hematoma Subdural/diagnóstico , Hematoma Subdural/cirurgia , Humanos , Aumento da Imagem , Hipotensão Intracraniana/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielografia , Exame Neurológico , Recidiva , Reoperação , Derrame Subdural/diagnóstico , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
AIMS: Trigeminal neuropathic pain is a broad diagnostic category that includes pain of several etiologies and excludes trigeminal neuralgia. The authors report a prospective series of percutaneous gasserian ganglion stimulation for trigeminal neuropathic pain. METHODS: Patients who experienced >50% reduction in pain from a 7- to 10-day trial period underwent permanent implantation and were prospectively followed. RESULTS: Eight of 10 trialed patients received a permanent implant. At the 12-month follow-up, 2 patients had been explanted and 1 was lost to follow-up. Three (all working at that the time) continued to experience >50% improvement in pain. DISCUSSION: The results in this series were variable but 3 patients showed long-term improvements. Patients who continued to work responded better to treatment.