Microvascular decompression of the trigeminal nerve in the treatment of SUNCT and SUNA

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 81; no. 9; pp. 992 - 996
• Main Authors: Williams, Max, Bazina, Renata, Tan, Leong, Rice, Hal, Broadley, Simon A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.09.2010; BMJ Publishing Group LTD
• Subjects: Aged; autonomic; Classification; Decompression, Surgical - adverse effects; Decompression, Surgical - methods; Female; headache; Headaches; Humans; Magnetic Resonance Imaging; Male; microvascular decompression; Microvessels - surgery; Middle Aged; neurosurgery; Pain; SUNA; SUNCT; SUNCT Syndrome - surgery; Surgery; treatment; Trigeminal Autonomic Cephalalgias - surgery; trigeminal nerve; Trigeminal Nerve - blood supply; trigeminal neuralgia
• ISSN: 0022-3050; 1468-330X; 1468-330X
• DOI: 10.1136/jnnp.2009.182824

BackgroundMedical management of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) syndrome and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) is often unsatisfactory.MethodsThe authors report nine cases of SUNCT/SUNA that failed medical treatment and had an aberrant arterial loop either in contact with or compressing the appropriate trigeminal nerve demonstrated on MRI. All underwent microvascular decompression of the ipsilateral trigeminal nerve for intractable pain.ResultsImmediate and complete relief of SUNCT and SUNA symptoms occurred in 6/9 (67%) cases. This was sustained for a follow-up period of 9–32 months (mean 22.2). In 3/9 (33%) cases, there was no benefit. Ipsilateral hearing loss was observed in one case.ConclusionMedically intractable SUNCT and SUNA subjects with a demonstrable aberrant arterial loop impinging on the trigeminal nerve on neuroimaging may benefit from microvascular decompression.