Idiopatická orofaciální bolest je skupina bolestivých onemocnění obličeje a/nebo dutiny ústní nejasné etiologie. Řadí se k nim syndrom palčivých úst, perzistující idiopatická dentoalveolární bolest, perzistující idiopatická obličejová bolest a trvalá jednostranná obličejová bolest s přidruženými atakami. Jde o získaná onemocnění dospělého věku, nejčastěji postihují ženy v postmenopauzálním období. Etiologie těchto poruch není zcela objasněna, pravděpodobně zahrnuje změny na periferní i centrální úrovni somatosenzorického systému vč. neuropatie tenkých vláken, subklinické periferní neuropatie, alterace kmenových funkcí a změn v centrální inhibiční modulaci bolesti. Ačkoli někteří pacienti mylně považují za vyvolávající situaci zubní ošetření, kauzální souvislost s invazivním zákrokem v dutině ústní nebyla dosud jednoznačně prokázána. Diagnostika je založena na zhodnocení klinických charakteristik bolesti a vyloučení sekundární příčiny. Strategie léčby spočívá v akutní topické aplikaci některých léčiv nebo dlouhodobé léčbě v off-label indikaci (antidepresiva, protizáchvatová medikace). Úspěšnost farmakologické léčby může být limitovaná, často též z důvodu nežádoucích vedlejších účinků. Experti se shodují, že časná diagnostika a farmakologická terapie jsou pozitivními prognostickými faktory, naopak opakované invazivní zákroky prognózu zhoršují. Komorbidní depresivní a úzkostné symptomy postihují zhruba jednu třetinu až polovinu pacientů. Psychosociální stres může zhoršovat průběh onemocnění. Ke spontánnímu zlepšení stavu dochází pouze u menší části pacientů (nejvíce jedna třetina), obvykle po dvou až sedmi letech trvání nemoci. Zásadním prvkem zůstává poskytnutí dostatečných informací o diagnóze a ujištění pacienta o neurobiologické povaze onemocnění. Žádoucí je využití podpůrné psychoterapeutické léčby.

Idiopathic orofacial pain is a group of painful disorders affecting the facial region and/or oral cavity with unclear etiology. This group includes burning mouth syndrome, persistent idiopathic dentoalveolar pain, persistent idiopathic facial pain, and constant unilateral facial pain with additional attacks. These are acquired diseases of adulthood, most commonly affecting postmenopausal women. The etiology of these disorders is not entirely understood, but likely involves changes at both the peripheral and central levels of the somatosensory system, including small fiber neuropathy, subclinical peripheral neuropathy, alterations in brainstem functions, and changes in central inhibitory pain modulation. Although some patients mistakenly consider dental treatment as the triggering situation, a causal relationship with invasive procedures in the oral cavity has not been unequivocally proven. Diagnosis is based on evaluating the clinical characteristics of the pain and excluding secondary causes. Treatment strategies include acute topical application of certain medications or long-term off-label treatment (antidepressants, antiseizure medications). The effectiveness of pharmacological treatment may be limited, often due to side effects. Expert agreement is that early diagnosis and pharmacological therapy are positive prognostic factors, while repeated invasive procedures worsen the prognosis. Comorbid depressive and anxiety symptoms affect roughly one-third to one-half of patients. Psychosocial stress can exacerbate the disease course. Spontaneous improvement occurs in only a minority of patients (at most one-third), usually after two to seven years of disease duration. Providing sufficient information about the diagnosis and reassuring the patient about the neurobiological nature of the disease remains crucial. Supportive psychotherapeutic treatment is also recommended.

• Keywords
• syndrom palčivých úst, dentoalveolární bolest,
• MeSH
• Humans MeSH
• Trigeminal Neuralgia diagnosis   therapy   MeSH
• Facial Pain * diagnosis   psychology   therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

BACKGROUND AND OBJECTIVES: Trigeminal neuralgia affects approximately 2% of patients with multiple sclerosis (MS) and often shows higher rates of pain recurrence after treatment. Previous studies on the effectiveness of stereotactic radiosurgery (SRS) for trigeminal neuralgia did not consider the different MS subtypes, including remitting relapsing (RRMS), primary progressive (PPMS), and secondary progressive (SPMS). Our objective was to investigate how MS subtypes are related to pain control (PC) rates after SRS. METHODS: We conducted a retrospective multicenter analysis of prospectively collected databases. Pain status was assessed using the Barrow National Institute Pain Intensity Scales. Time to recurrence was estimated through the Kaplan-Meier method and compared groups using log-rank tests. Logistic regression was used to calculate the odds ratio (OR). RESULTS: Two hundred and fifty-eight patients, 135 (52.4%) RRMS, 30 (11.6%) PPMS, and 93 (36%) SPMS, were included from 14 institutions. In total, 84.6% of patients achieved initial pain relief, with a median time of 1 month; 78.7% had some degree of pain recurrence with a median time of 10.2 months for RRMS, 8 months for PPMS, 8.1 months for SPMS ( P = .424). Achieving Barrow National Institute-I after SRS was a predictor for longer periods without recurrence ( P = .028). Analyzing PC at the last available follow-up and comparing with RRMS, PPMS was less likely to have PC (OR = 0.389; 95% CI 0.153-0.986; P = .047) and SPMS was more likely (OR = 2.0; 95% CI 0.967-4.136; P = .062). A subgroup of 149 patients did not have other procedures apart from SRS. The median times to recurrence in this group were 11.1, 9.8, and 19.6 months for RRMS, PPMS, and SPMS, respectively (log-rank, P = .045). CONCLUSION: This study is the first to investigate the relationship between MS subtypes and PC after SRS, and our results provide preliminary evidence that subtypes may influence pain outcomes, with PPMS posing the greatest challenge to pain management.

• MeSH
• Pain etiology   surgery   MeSH
• Humans MeSH
• Neoplasm Recurrence, Local surgery   MeSH
• Pain Management methods   MeSH
• Trigeminal Neuralgia * radiotherapy   surgery   MeSH
• Radiosurgery * methods   MeSH
• Retrospective Studies MeSH
• Multiple Sclerosis * surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

BACKGROUND: Percutaneous rhizotomy of the Gasserian ganglion is a well-established intervention for patients suffering from refractory trigeminal pain, not amenable to pharmacological management or microvascular decompression. Traditionally conducted under fluoroscopic guidance using Hartel's technique, this study investigates a modified approach employing low-dose CT guidance to achieve maximal procedural precision and safety with the emphasis on minimizing radiation exposure. METHODS: A retrospective analysis of patients undergoing percutaneous rhizotomy of the Gasserian ganglion at our institution was undertaken. Procedures were divided into fluoroscopy and CT-guided foramen ovale (FO) cannulation cohorts. Radiation doses were assessed, excluding cases with incomplete data. The study included 32 procedures in the fluoroscopy group and 30 in the CT group. RESULTS: In the CT-guided group, the median effective dose was 0.21 mSv. The median number of CT scans per procedure was 4.5, and the median procedure time was 15 min. Successful FO cannulation was achieved in all 30 procedures (100%). In the fluoroscopy group, the median effective dose was 0.022 mSv, and the median procedure time was 15 min. Cannulation of FO was successful in 31 of 32 procedures (96.9%). The only complications in the CT-guided group were three minor cheek hematomas. Immediate pain relief in the CT-guided group was reported in 25 of 30 procedures (83.3%), 22 of 30 (73.3%) provided relief at one month, and 10 of 18 (55.6%) procedures resulting in pain relief at one month continued to provide relief after two years. CONCLUSION: Low-dose CT-guided percutaneous rhizotomy conducted in the radiology suite carries negligible radiation exposure for patients and eliminates it for personnel. This method is fast, simple, precise, and carries a very low risk of complications.

• MeSH
• Radiation Dosage MeSH
• Adult MeSH
• Fluoroscopy methods   MeSH
• Trigeminal Ganglion surgery   diagnostic imaging   MeSH
• Middle Aged MeSH
• Humans MeSH
• Trigeminal Neuralgia * surgery   diagnostic imaging   radiotherapy   MeSH
• Tomography, X-Ray Computed * methods   MeSH
• Radiation Exposure * prevention & control   MeSH
• Retrospective Studies MeSH
• Rhizotomy * methods   MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

• Keywords
• caustinum AKH,
• MeSH
• Adult MeSH
• Homeopathy MeSH
• Humans MeSH
• Materia Medica * therapeutic use   MeSH
• Trigeminal Neuralgia * drug therapy   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

BACKGROUND AND OBJECTIVES: Trigeminal Neuralgia (TN) is a debilitating facial pain disorder, often necessitating surgical interventions when medication proves insufficient. Stereotactic Radiosurgery (SRS) is an established therapeutic option. Limited studies explored the feasibility of a third SRS procedure. Our study investigates the safety and efficacy of a third SRS procedure for recurrent TN. METHODS: We performed a retrospective analysis across multiple centers using databases collected prospectively. Pain status was evaluated utilizing the BNI Pain Intensity Scales. The Kaplan-Meier method was employed to estimate the time to recurrence, with group comparisons conducted using log-rank tests. Associations were explored using Chi-square and logistic regression models. RESULTS: Ten institutions contributed with a total of 35 patients. A third SRS revealed sustained effectiveness with a pain control rate of 82.7%. The median time to recurrence was 35.5 months. New sensory dysfunction following the third procedure occurred in 22% of patients who had preserved sensory function after the second procedure. When considering those who developed sensory dysfunction after the second procedure, 40% of the entire cohort was affected. There were no significant differences in pain recurrence intervals among the three procedures. A meta-analysis, combining data from previous studies, showed that 89.6% of patients achieved some degree of pain control after a third SRS, with 27.4% experiencing new sensory dysfunction and a median time to recurrence of 31.6 months. CONCLUSION: Our study, the largest on the topic, affirms the sustained effectiveness of a third SRS for TN, providing comparable pain relief to initial procedures. Notably, an extended pain-free interval after the third SRS session was observed. Facial sensory dysfunction emerged as the primary side effect. Larger studies are warranted to explore correlations with demographics and treatment parameters for a comprehensive understanding of repeat SRS in managing recurrent TN.

• MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Trigeminal Neuralgia * surgery   MeSH
• Radiosurgery * methods   adverse effects   MeSH
• Recurrence * MeSH
• Reoperation MeSH
• Retrospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

BACKGROUND: The cranial nerve (CN) V and adjacent neurovascular structures are crucial landmarks in microvascular decompression (MVD). MVD of CN V is the most effective treatment for patients with drug-resistant trigeminal neuralgia (TN) diagnosis. The endoscope-assisted retrosigmoid approach (RSA) provides better exposure and less cerebellar retraction in the corridor towards the cerebellopontine angle (CPA). METHODS: Five adult cadaver heads (10 sides) underwent dissection of the MVD in park bench position. MVD was simulated using microsurgical RSA, and the anatomical landmarks were defined. Microsurgical dissections were additionally performed along the endoscopic surgical path. Additionally, we present an illustrative case with TN caused by anterior inferior cerebellar artery (AICA) compression. The CN V and its close relationships were demonstrated. Endoscopic and microscopic three-dimensional pictures were obtained. RESULTS: This study increases the anatomical and surgical orientation for CN V and surrounding structures. The CN V arises from the lateral part of the pons and runs obliquely upward toward the petrous apex. It has motor roots that leave from pons antero-supero-medial direction to the sensory root. The endoscopic instruments provide perfect visualization with minimal cerebellar retraction during MVD. CONCLUSION: MVD surgically targets the offending vessel(s) leading to TN and aims to create a disconnected area. The combination of preoperative radiographic assessment with and anatomical correlation provides safe and effective application while facilitating selection of the most appropriate approach. The RSA allows satisfactory visualization for CN V. Endoscope-assisted microsurgery through the CPA is a challenge, it should be performed with advanced anatomical knowledge.

• MeSH
• Endoscopy methods   MeSH
• Humans MeSH
• Microvascular Decompression Surgery * methods   MeSH
• Trigeminal Neuralgia * surgery   MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

• Keywords
• Chirurgie, ortopedie, traumatologie,
• MeSH
• Neurosurgery MeSH

• NML Fields
• neurochirurgie

Na pracovišti ambulance bolesti v Českých Budějovicích se v posledních dvou letech věnujeme ošetřování akutní progrese chronických bolestí hlavy intranazální aplikací lidokainu. Jedná se o ambulantní, minimálně invazivní a pacienty dobře snášenou metodu. V poloze vleže podáváme malé množství 4% lidokainového gelu opakovaně po 3–5 minutách celkem 3–5krát nosní dírkou na postižené bolestivé polovině hlavy. Aplikátor zavádíme po znecitlivění vstupu do nosu šetrně až do kontaktu se zadní stěnou nosohltanu, pod jehož sliznicí se nachází trigeminální ganglion. Cílem ošetření je ovlivnit lokálním anestetikem ganglion sphenopalatinum a snížit vedení bolesti v povodí trigeminálního nervu z postižené poloviny hlavy a obličeje. Zákrok provádíme opakovaně třikrát týdně. Výkon často kombinujeme s podáním antineuropatické infuze. Metodu jsme vyzkoušeli u pacientů s postherpetickými bolestmi obličeje, při atakách bolestí hlavy u pacientů s roztroušenou sklerózou, u pacientů čekajících na intervenční zákrok při neuralgiích trigeminu na podkladě neurovaskulárního konfliktu. Dobrý efekt byl pozorován i u akutních postpunkčních bolestí hlavy a u migrény. Úlevu od bolesti lze pozorovat po 1–2 hodinách a trvání efektu léčby je velmi individuální: 2 dny až 4 týdny. Opakování zákroku obden a současná aplikace antineuropatické infuze nebo myorelaxační infuze potencují analgetický účinek. Ošetření bývá pacienty dobře snášeno. Při zavádění aplikátoru může dojít k poranění nosní sliznice, během aplikace je patrné slzení, necitlivost a pocit chladu pod okem a v okolí jařmového oblouku ošetřované strany. Občas se vyskytne pálení v oblasti nosohltanu ze zatékajícího lidokainového gelu, což se dá ovlivnit množstvím aplikované látky. Ze zájmu pacientů o opakování aplikace lze usuzovat na pozitivní efekt metody.

At the pain clinic in Budweis, we have been treating the acute progression of chronic headaches using intranasal lidocaine for the past two years. It is an outpatient, minimally invasive method that is well tolerated by patients. In the supine position, we administer a small amount of 4 % lidocaine gel repeatedly after 3-5 minutes a total of 3-5 times through the nostril on the affected painful half of the head. After anesthetizing the entrance to the nose, the applicator is gently inserted until it comes into contact with the back wall of the nasopharynx, under the mucosa of which the trigeminal ganglion is located. The aim of the treatment is to affect the sphenopalatine ganglion with a local anesthetic and to reduce the conduction of pain in the basin of the trigeminal nerve from the affected half of the head and face. We perform the procedure repeatedly 3 times a week. We often combine the procedure with the administration of an antineuropathic infusion. We tried the method in patients with post-herpetic facial pain, in headache attacks in patients with multiple sclerosis, in patients waiting for intervention for trigeminal neuralgia based on neurovascular conflict. A good effect was also observed in acute postpuncture headaches and migraines. The effect can be observed after 1-2 hours and the duration is very individual from 2 days to 4 weeks. Repeating the procedure every other day and simultaneous application of antineuropathic infusion or myorelaxant infusion potentiate the analgesic effect. Treatment is usually well tolerated by patients. When inserting the applicator, the nasal mucosa may be injured, during the application there is steamy lacrimation, numbness and a feeling of coldness under the eye and around the zygomatic arch of the treated side. Sometimes there is a burning sensation in the nasopharynx area from leaking lidocaine gel, which can be influenced by the amount of applied substance. The positive effect of the method can be inferred from the patients‘ interest in repeating the application.

• MeSH
• Administration, Intranasal * methods   adverse effects   MeSH
• Headache * etiology   drug therapy   classification   MeSH
• Adult MeSH
• Tooth Extraction adverse effects   MeSH
• Ganglia, Parasympathetic drug effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Lidocaine * administration & dosage   adverse effects   therapeutic use   MeSH
• Trigeminal Nerve physiology   MeSH
• Trigeminal Neuralgia etiology   drug therapy   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH
• Review MeSH

Neuralgie trojklaného nervu (TN) je bolestivý syndrom charakterizovaný paroxysmálními, silnými bolestmi v oblasti obličeje, v distribuční oblasti trojklaného nervu. Sekundární TN je způsobena jiným základním onemocněním, jako jsou nádory či cévní malformace. Nádorem indukovaná sekundární neuralgie vyžaduje včasnou diagnostiku a správnou strategii léčby. Farmakoterapie má omezený účinek, a chirurgický zákrok se často stává nezbytným. Stereotaktická radiochirurgie (SRS) se stala důležitou alternativou pro pacienty, kteří nejsou kandidáty na chirurgickou resekci, nebo ji odmítají. SRS může být zaměřena na samotný nádor nebo na trojklaný nerv, s různými mírami úspěchu a senzorických poruch. Kombinace chirurgické resekce a SRS je efektivní u významné části pacientů s neúspěšnou předchozí léčbou. Individualizovaný přístup k léčbě TN je klíčem k dosažení optimálních výsledků a minimalizaci komplikací.

Trigeminal neuralgia (TN) is a painful syndrome characterized by paroxysmal, intense pain in the facial area distributed along the trigeminal nerve. Secondary TN is caused by other underlying conditions, such as tumors or vascular malformations. Tumor-induced secondary neuralgia requires early diagnosis and the right treatment strategy. Pharmacotherapy has limited efficacy, and surgical intervention often becomes necessary. Stereotactic radiotherapy (SRS) has become an important alternative for patients who are not candidates for surgical resection or who refuse it. SRS can be targeted at either the tumor itself or the trigeminal nerve, with varying degrees of success and sensory disturbances. A combination of surgical resection and SRS is effective in a significant portion of patients with previous unsuccessful treatment. An individualized approach to TN treatment is key to achieving optimal outcomes and minimizing complications.

• Keywords
• Leksellův gama nůž,
• MeSH
• Humans MeSH
• Magnetic Resonance Imaging, Interventional MeSH
• Brain Neoplasms surgery   mortality   radiotherapy   MeSH
• Trigeminal Neuralgia * diagnosis   etiology   pathology   radiotherapy   MeSH
• Radiosurgery * instrumentation   MeSH
• Stereotaxic Techniques MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

Herpes zoster (pásový opar) je akutní segmentální onemocnění s kožními a neurologickými projevy většinou typického klinického obrazu a průběhu způsobené virem varicella zoster (VZV) ze skupiny herpesvirů. Je výrazem reaktivace viru, který po primoinfekci planými neštovicemi přetrvává v senzitivních gangliích lidského těla. K aktivaci dochází vlivem imunosuprese dané věkem, onemocněním, imunosupresivní léčbou nebo jiným zátěžovým faktorem. Řadí se mezi prekancerózy, a proto je doporučeno pacienty po proběhlém pásovém oparu screeningově vyšetřit. Zvláště u imunokompromitovaných jedinců může mít těžší průběh a být spojen s vážnými až letálními komplikacemi. Při výsevu v oblasti hlavových nervů (tzv. herpes zoster trigeminalis) je průběh provázen ještě dalšími projevy v důsledku lokalizace procesu, z nichž závažná mohou být oční postižení a extrémní trigeminální bolestivost. Při nedostatečné nebo pozdě zahájené terapii jsou následnou komplikací postherpetické neuralgie. Vzhledem k intenzitě a době trvání i několika měsíců jsou velmi obtěžující a vyčerpávající. Ve starší literatuře jsou řazeny dokonce mezi příčiny sebevražd. V prevenci pásového oparu se v posledních letech udělal velký pokrok. Článek pojednává o etiologii, klinických příznacích a současných terapeutických doporučeních.

Shingles (herpes zoster) is an acute segmental disease with skin and neurological manifestations, usually typical of the clinical picture and course, which is caused by the varicella-zoster virus (VZV) of the herpesvirus group. It is an expression of reactivation of the virus, which persists in the sensitive ganglia of the human body after primoinfection with chickenpox. Reactivation occurs as a result of immunosuppression due to age, disease, immunosuppressive treatment or another stress factor. Since it is classified as precancerous, screening patients is recommended after shingles. The course of the diseases may be more severe in individuals with a compromised immune system, and it may even be associated with serious to fatal complications. Due to the location of the process, the course of herpes zoster trigeminalis is accompanied by additional symptoms, the most serious of which may involve eye problems and extreme trigeminal pain. Inadequate or late onset of therapy results in postherpetic neuralgia. Due to the intensity and the fact that it may even last several months, they are very bothersome and debilitating. In the older literature, shingles is even classified as a cause of suicide. Much progress has been made in the prevention of shingles in recent years. This article discusses the etiology, clinical signs, and current therapeutic recommendations.