BACKGROUND Trigeminal Neuralgia (TN) is a well-recognized facial pain syndrome. Discrete forms with disparate pain symptoms include TN1 and TN2, however, atypical facial pain includes neuralgiform pain along a spectrum. The majority of TN is diagnosed in the adult population. Case reports and series in children present TN as a similar diagnosis which can be similarly treated as in adults. This manuscript reviews pertinent literature and presents two pediatric TN cases successfully treated with microvascular decompression (MVD). CASE DESCRIPTION Two pediatric patients (ages 12 and 15) were identified with TN that was refractory to previous medical therapy. The patients were both deemed appropriate surgical candidates and were treated with MVD to manage their TN. TN compression was arterial in both cases and involved portions of the anterior inferior cerebellar artery. Patient 1 was found to be pain-free 6 months following the procedure. Patient 2 was pain-free immediately following the procedure and has since been weaned off preoperative symptomatic management. The most recent follow-up is 12 and 8 months, respectively, with continued pain freedom. CONCLUSIONS There are few reports on the effectiveness of MVD in the pediatric population for the management of TN. Supporting literature, as well as the cases presented, demonstrate that MVD is an effective treatment for pediatric patients in managing their TN. Furthermore, there appears to be minimal side effects, with excellent pain relief with MVD in this patient population.
Approximately 1% of injuries to bicyclists are associated with dogs; one-half sustained a bite. Potential/proposed prevention strategies could be educational materials regarding bicycles and dogs to owners, dog restraint, student/parent education and educational materials in waiting rooms of veterinarians, paediatricians, family practice physicians and emergency rooms.
Severe lower limb spasticity can hinder motor tasks and negatively impacts the quality of life in patients with cerebral palsy. Selective dorsal rhizotomy is a well-established neurosurgical intervention aimed at reducing muscle spasticity in patients with such neuromuscular conditions. Long-term outcomes of selective dorsal rhizotomy have been promising among the authors’ institutional series of patients. In this case, we demonstrate the use of L1-S1 osteoplastic laminoplasty and L1-S1 selective dorsal rhizotomy in a 5-year-old male patient with cerebral palsy and spastic lower extremity diplegia. Favorable selection criteria for this case included disabling lower extremity diplegia, young age, good core strength, no cognitive delay, and strong rehabilitation potential. The patient's preoperative functional status was noncommunity ambulator (Gross Motor Function Classification System Level III) with walker use and good dynamic balance. Prior to the procedure, he demonstrated an overall decreased muscle strength in bilateral lower extremities with bilateral hamstring spasticity (Ashworth 3) and bilateral heel cord spasticity (Ashworth 4). Rhizotomy was performed with identification and selective sectioning of dorsal nerve roots with abnormal stimulation patterns. Fibers with unsustained discharge of appropriate muscles were identified and spared. No intraoperative or postoperative complications were encountered. The patient had minimal back pain and surgical morbidity postoperatively. Following the procedure and highly structured inpatient and outpatient rehabilitation therapies, the patient exhibited significant improvement in gait velocity (84%) and gait cadence (66%) at 5 months. Additionally, the patient demonstrated greater independence of activities of daily living and improvements in mobility by Pediatric Evaluation Disability Index. Patient consent was obtained from the parent.
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