A recent article “Radiosurgery for Short Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing (SUNCT) Syndrome: Targeting the Trigeminal Nerve and the Sphenopalatine Ganglion” discusses treatment of SUNCT by utilizing Gamma Knife surgery.
The patient in this report had periodical episodes of severe pain in increasing frequency and severity. While surgery is never a first choice in this case it was somewhat effective with pain improving graduallty over several months in both frequecy and severity.
This patient would have been a excellent candidate for Self Administration of Sphenopalatine Ganglion Blocks (SASPGB). This patient did have infiltration of the Sphenopalatine Ganglion but neuralgia type pain responds best to high frequency SPG Blocks. Typically patients taught Self Administration will begin with twice dail applications. These applications utilize cotton-tipped catheters and provide continuous release of anesthetic by capillary action. This is done for a minimum of 20 minutes but continual delivery is possible for several hours.
Lidocaine (2%) acts as a natural anti-inflamatory and can also give time for CNS inflamtion to heal.
SUNCT should be treated ideally with daily self-administration of lidocaine SPG Blocks prior to surgical intervention.
World Neurosurg. 2020 Jan;133:167-171. doi: 10.1016/j.wneu.2019.10.016. Epub 2019 Oct 10.
Gamma Knife Radiosurgery for Short Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing (SUNCT) Syndrome: Targeting the Trigeminal Nerve and the Sphenopalatine Ganglion. Case Report and Literature Review.
Zaed I1, Attuati L2, Tommasino C3, Arosio EM4, Navarria P5, Stravato A6, Colombo G7, Picozzi P2.
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a primary headache syndrome with an unclear pathogenesis, and only in very few cases, SUNCT is secondary to known lesions (secondary SUNCT). Several pharmacological as well as interventional and invasive treatments have been used to treat SUNT cases, with no definitive results. We describe a patient with idiopathic SUNCT syndrome, successfully treated with gamma knife radiosurgery and we report a review of the cases of the literature treated with radiosurgery.
A 63-year-old woman complained of episodes of intense and regular paroxysmal facial pain in the territory of the maxillary branch of the trigeminal nerve accompanied by inflammation of conjunctiva and involuntary lacrimation from 2006. During the following years, she received several treatments: combination of drugs, acupuncture, and endonasal infiltration of the sphenopalatine ganglion. The frequency of the painful attacks increased progressively and it was impossible for her to have a normal active life. Combined gamma knife radiosurgery treatment, targeting the trigeminal nerve (80 Gy maximum dose) and the sphenopalatine ganglion (80 Gy maximum dose) was performed in April 2016 (visual analog score before treatment = 6). Pain gradually reduced in the following months, as well as frequency and severity of the attacks. No sensory deficit developed. The follow-up length of our patient is 37 months: she is nearly pain free (visual analog score = 2) and has resumed a normal life.
Patients with idiopathic SUNCT have few therapeutic options. Our case demonstrates that gamma knife radiosurgery is a feasible and effective noninvasive option to treat patients with medically refractory idiopathic SUNCT.
Copyright © 2019 Elsevier Inc. All rights reserved.
Gamma knife radiosurgery; Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing; Sphenopalatine ganglion; Trigeminal nerve