Is anaesthesia for trigeminal thermocoagulation ever necessary?
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Biomedical subjects
Publications and source records attributed to G Salar.
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We describe the case of a patient who, during the percutaneous thermocoagulation of the petrous ganglion of Andersch, suffered a serious vagal response resulting in cardiac arrest, collapse, and generalized convulsions. Notwithstanding such major symptoms, the postoperative examination revealed no lesions of the vagus nerve and the glossopharyngeal lesion was shown to be isolated and selective.
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Percutaneous thermocoagulation of the Gasserian ganglion allows a good preservation of facial touch sensation with a complete and immediate regression of the symptomatology in a majority of cases. Neurophysiological bases are the peculiar resistance to the thermal lesion of the large myelinated fibers compared to the relatively smaller fibers. The study of the cortical-evoked responses before and after surgery suggests that the afferent volley travels in preference along these large myelinated fibers.
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The beta-endorphin content in cerebrospinal fluid (CSF) was evaluated in 10 patients with idiopathic trigeminal neuralgia during medical treatment (with or without carbamazepine) and after selective thermocoagulation of the Gasserian ganglion. These values were compared with those obtained in a control group of seven patients without pain problems. No statistically significant difference was found between patients suffering from trigeminal neuralgia and those without pain. Furthermore, neither pharmacological treatment nor surgery changed CSF endorphin values. It is concluded that there is no pathogenetic relationship between trigeminal neuralgia and endorphins.
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A rare case of intracranial hypertension associated with subarachnoid bleeding from a spinal tumour is reported. Clinical features, review of the literature and pathogenetic factors are discussed.
Percutaneous electrostimulation, acupuncture, and direct stimulation of the central nervous system are supposed to be capable of reducing painful sensation by releasing enkephalins and endorphins. We treated six volunteers with electrotherapy, obtaining in all cases a clear reduction of the pain induced by electric stimulation of the median nerve at the wrist. During the treatment, the administration of naloxone, an antagonist of morphine, in four subjects provoked a short but clear and immediate return of pain. In the other two cases, the drug provoked a further decrease of the painful sensation. During electro-stimulation in all patients, the somatosensory evoked potentials showed a statistically significant decrease. In the four "naloxone-responsive" subjects, the cortical evoked responses returned to basal amplitude after naloxone. In the two patients with a clinically paradoxic response, nonsignificant modification in the cortical evoked potentials was noted.
One hundred and forty consecutive subarachnoid haemorrhages (SAH) which presented either an intracranial vascular malformation (102 cases: aneurysm 80 cases, AVH 22 cases) or remained of "unknown aetiology" (38 cases) were studied. SAH caused by other factors (neoplasms, thrombo-embolisms, systemic diseases etc.) were excluded. The 38 cases with bleeding of "unknown aetiology" have been studied by complete cerebral angiography, pneumoencephalogram or CT scan, and have been followed for two years. The most important clinical factors in the three groups have been compared by a statistical method to verify the hypothesis that SAH of "unknown aetiology" is caused by vascular micromalformations which are angiographically not evident either because of their small size or because of their "spontaneous" recovery after bleeding due to thrombosis and disappearance of the malformation. From the data collected it may be concluded that SAH of "unknown aetiology" is a benign lesion, typically occurring in middle age, but with no clear characteristics that enable identification of the anatomical substratum from it originates.
Three cases of an infrequent cerebral vascular malformation, venous angioma, are reported. The first 2 of these cases, with the lesion in a supratentorial location, exhibited exophthalmos as a presenting symptom, together with palpebral or intraobital angiomatous formations, and also impairment of visual function. The first patient was operated upon and the "venous angioma" could be confirmed histologically. An angiographic follow-up of the same patient at an 18 year interval was also possible. The diagnostic work-up to be performed in cases of exophthalmos is discussed and the need for angiography is stressed.
The experience with the use of RIHSA cisternography in cases of spontaneous or posttraumatic CSF rhinorrhea is reported. The utility of this method for identifying the fistulous tract so that the neurosurgeon can, as far as he is able, carry out a direct and not solely exploratory operation is pointed out.
This patient developed an intracranial carotid artery aneurysm after a bullet wound. A review of the related literature, and the pathogenesis of traumatic false and true aneurysms are presented.
Transcutaneous electrotherapy has been employed in 112 patients with chronic pains of various origins. The immediate and long term results are not considered, at whole, satisfactory, especially for length and quality of the obtained improvement. Only patients with chronic post-zoosterian neuralgia had good results, or immediate either at long term, especially in intercostal pains. In the contrary in acute cases of this nevralgia, there were not satisfactory improvements.
Recently, Mayer (1977) and Adams (1976) proved that both acupuncture and direct electrostimulation of deep encephalic structures produce an analgesic effect releasing a neurotransmitter similar to morphine (endorphine). We have verified this hypothesis, using the transcutaneous electrotherapy in five patients with chronic pain at the back (postherpetic neuralgia in 3, pain cancer in 2). All patients related a certain analgesic effect during electrotherapy, with a reduction in pain of more than 50 per cent. During electroanalgesia we administered Naloxone (an antagonist of morphine). In 3 cases we observed a clear, although short, return of algic symptomatology. At the contrary, in other two patients Naloxone caused briefly a further and clear reduction in the pain.
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The authors describe the case of a patient affected by an aneurysmal bone cyst of the fronto-parietal bone. A short review of the literature follows.