Facial pain due to vascular lesions of the brain stem relieved by dorsal root entry zone lesions in the nucleus caudalis

Report of two cases

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✓ One patient with a pontine infarct due to a fusiform basilar artery aneurysm and one with an arteriovenous malformation within the tectum of the mesencephalon developed intractable facial pain. This pain was relieved in both patients by radiofrequency lesions in the dorsal root entry zone of the trigeminal nucleus caudalis.

Article Information

Address reprint requests to: John H. Sampson, M.D., Division of Neurosurgery, Duke University Medical Center, Box 3807, Durham, North Carolina 27710.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 1. Anterior (left) and lateral (right) vertebral angiograms demonstrating a large, tortuous, and partially thrombosed fusiform basilar aneurysm that resulted in a pontine infarct. At the cerebellopontine angle, the aneurysm lay on the left but crossed the midline to lie fully on the right at the base of the pons.

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    Schematic diagram showing the relationship of the trigeminal nerve subdivisions (V1, V2, V3) and the spinocerebellar tracts. The first division of the trigeminal nerve is represented nearest the spinal accessory nerve, and central regions of the face are somatotropically represented in the rostral part of the nucleus (A, B, C). The inset shows how the insulated caudalis dorsal root entry zone (DREZ) electrode spares the spinocerebellar tracts. XI = 11th cranial nerve; C1, C2, C3 = cervical nerve rootlets.

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    Preoperative vertebral subtraction angiograms demonstrating an arteriovenous malformation (AVM) in the tectum of the mesencephalon. Left: Angiogram showing early venous drainage in the vein of Galen (A) and the AVM in the tectum of the mesencephalon (B). Right: Angiogram showing the draining vein (A) and the superior cerebellar artery feeder (B).

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