title: Nucleus caudalis dorsal root entry zone lesioning for the treatment of anesthesia dolorosa.
abstract: Deafferentation facial pain (anesthesia dolorosa) can occur after injury of the first-order trigeminal nerve. It is often debilitating and difficult to treat. The authors report the treatment of anesthesia dolorosa in a 69-year-old man with a 7-year history of pain. The pain occurred after an open resection of a right trigeminal neuroma. After treatment with medications failed, the patient was treated with nucleus caudalis (dorsal root entry zone) lesioning. His facial pain was immediately and completely eliminated. The authors describe the technique of this central neuroablative procedure, and they review the available literature regarding this procedure as well as the current evidence base for neuromodulatory surgeries. After the 1-year follow-up, the authors conclude that the patient attained lasting relief.
authors.affiliation: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York 14642, USA. Stephen_Sandwell@URMC.Rochester.edu
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Sandwell
authors.forename: Amr O
authors.initials: AO
authors.lastname: El-Naggar
mesh_terms: D000368:Aged; D003390:Cranial Nerve Neoplasms / Q000601:surgery*; D005157:Facial Pain / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009407:Nerve Block / Q000379:methods*; D009463:Neuroma / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods*; D010147:Pain Measurement; D012720:Severity of Illness Index; D013126:Spinal Nerve Roots / Q000601:surgery*; D016896:Treatment Outcome; D014275:Trigeminal Caudal Nucleus / Q000601:surgery*