Giuseppe Salar

Percutaneous thermocoagulation for sphenopalatine ganglion neuralgia

SummaryThe authors describe percutaneous radiofrequency (rf) thermocoagulation of the sphenopalatine ganglion used to treat seven patients with sphenopalatine ganglion neuralgia.The procedure was effective in relieving pain, without significant side-effects. All the patients have actually been free of pain during a follow-up of 6–28 months. The surgical technique and the rationale for its use are pointed out.

Selective percutaneous thermolesions of the ninth cranial nerve by lateral cervical approach: report of eight cases

Percutaneous radiofrequency thermolesion of the petrous ganglion at the jugular foramen was employed for the treatment of glossopharyngeal neuralgia in eight cases, three with essential and five with symptomatic pain from oropharyngeal cancer. Because of its technical simplicity, the lateral cervical approach was preferred to the anterior lateral approach. Immediate and subsequent surgical results were satisfactory. No neurological complication was noted, except for transitory bradycardia and hypotension during the procedure.

Alterations of facial sensitivity induced by percutaneous thermocoagulation for trigeminal neuralgia

Sixty patients with essential trigeminal neuralgia underwent selective percutaneous thermocoagulation of the gasserian ganglion. Immediate and long-term modifications of pain and tactile facila sensitivity, recurrences of pain, and occurrences of facial paresthesias were evaluated. Pin-prick and von Frey hair tests and somatosensory-evoked potentials were used to study facila sensitivity. Patients with mild alterations of sensitivity-treated with low temperatures of coagulation (60 degrees-70 degrees C)--had a lower incidence of paresthesias, although a higher risk of recurrence. Patients with severe alterations of sensitivity--a consequence of a temperature of coagulation above 70 degrees C--had a high incidence of paresthesias and a low risk of recurrence. In our opinion, the first kind of results are better.

Percutaneous Glossopharyngeal Thermocoagulation Complicated by Syncope and Seizures

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.

Cerebral blood flow changes induced by electrical stimulation of the Gasserian ganglion after experimentally induced subarachnoid haemorrhage in pigs

SummaryThe effect of trigeminal electrical stimulation on cerebral blood flow has been studied in conditions of normal or reduced cerebral blood flow (CBF).Autologous blood was injected into the subarachnoid space of ten Pittmann-Moore pigs to induce subarachnoid haemorrhage (SAH) accompanied by cerebral blood flow (CBF) reduction. One week later, in six of ten animals, a considerable decrease of CBF was noted as evaluated by means of a recording-system monitoring over the right parieto-temporal calvarium the washout of133 Xenon injected into the internal carotid artery after the external carotid had been clamped. Continuous electrical stimulation of the Gasserian ganglion performed in the six animals with severely induced CBF reduction produced a remarkable cerebrovascular dilation and increase of CBF lasting over 3 h.Electrical stimulation of the Gasserian ganglion produced a similar pattern of vasodilation in six pigs in which no blood was injected and no reduction of CBF was evident.The mechanisms and the anatomical pathways which underlie these results are discussed.

Cortical evoked responses and transcutaneous electrotherapy

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 electrostimulation in all patients, the somatosensory evoked potentials showed a statistically significant decrease. In the four “haloxone-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.

Cardiovascular and cerebral complications during glossopharyngeal nerve thermocoagulation

The cardiovascular and cerebral complications observed during percutaneous radiofrequency thermocoagulation of the glossopharyngeal nerve are described. The value of such symptoms in anticipating a lesion of the vagus nerve is discussed.

Diencephalic syndrome following cervical spinal cord trauma

SummaryThe authors discuss about five cases of diabetes insipidus observed in patients affected by traumatic cervical spine fractures and/ or dislocations, without either evident lesions of the cerebral structures at CT scan examination, or important craniocerebral trauma.In all patients polyuria and hyperthermia arose some days after the traumatic accident and regressed spontaneously or after exogeneous vasopressin administration.Vasopressin urinary levels confirmed the presence of a true diabetes insipidus, the origin of which is in largely obscure. A central medullary vasopressin mediated pathway, demonstrated only in experimental animals, may be responsible for such a finding.

Combined thermocoagulation of the 5th and 9th cranial nerves for oral pain of neoplastic aetiology

The authors report their limited but interesting experience in the treatment of intractable oral pain employing the technique of percutaneous radiofrequency thermocoagulation both of the trigeminal and glossopharyngeal nerves. The use of combined percutaneous thermolesions for cancer pain is rarely described in the literature. Immediate and long-term results confirm the usefulness of this surgical procedure.

Accidental high voltage electrocution: a rare neurosurgical problem

SummaryThe authors describe a case of accidental electrocution from a high voltage current in a young worker, who was struck by the electric shock in the mid-occipital region.The case is especially interesting due to the improbability of anyone surviving after receiving a shock of more than 1000 V., and to the development of bilateral parieto-occipital haemorrhagic infarction with spastic paraparesis, directly caused by the high voltage current and not indirectly by heat generation or secondary head trauma.