Pathogenesis, Surgical Treatment, and Cure for SUNCT Syndrome

Abstract

Microvascular decompression provides an appropriate therapeutic choice if vascular compression of the trigeminal nerve is identified. From our 2 cases, we propose that, in some cases of SUNCT diagnosed previously, characteristic symptoms were induced by compression of the side surface of the first branch of the trigeminal nerve at the root exit zone by the intracranial artery.

Secondary Short-Lasting Unilateral Neuralgiform Headache with Conjunctival Injection and Tearing: A New Case and a Literature Review

“…We summarized 69 cases of SUNCT-like conditions associated with certain etiologies in 62 English-language studies reported on from 1991 to 2017 and for which there were detailed descriptions of the clinical features and imaging results of the patients. These cases comprised 17 with neoplasm, 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 35 with neurovascular disease, 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 2 with trauma, 44 45 10 with infection, 46 47 48 49 50 51 52 53 54 3 with inflammatory disease, 55 56 57 and 2 with congenital malformation ( Table 1 , 2 , and 3 ). 58 59 …”

“…Thirty cases were caused by neurovascular compression, 19 20 22 24 25 26 27 28 30 31 32 33 34 35 36 39 40 41 42 43 four cases were due to cerebral infarction, 23 29 37 38 and one case was due to cavernous angioma. 21 MRI findings showed that 32 cases were at the pons level, including a case of left cerebellar infarction, while its ischemic penumbra was considered to involve the ascending spinothalamic tract and descending trigeminal fibers at or below their site of entry (and subsequent caudal passage) into the lateral pontine tegmentum.…”

“…Cases with cerebral infarction, 23 29 37 38 infection, 51 and demyelination 55 56 explicitly manifested in the Shadow-A area because they mainly exhibited lesions in the pons, dorsolateral medulla, and cervical spinal cord (C1 to C2) where the trigeminal divisions, trigeminal nucleus, spinothalamic tract, and trigeminohypothalamic tract are present and thus induce SUNCT. Neurovascular compression 19 20 22 24 25 26 27 28 30 31 32 33 34 35 36 39 40 41 42 43 was the most common reason in cases in the Shadow-B area, which could be clearly visualized using MRI and could accurately indicate vascular malformation in the CPA cistern that involves the trigeminal root entry zone and mostly irritates fibers of the first division (V1) of the trigeminal nerve and the greater petrosal nerve; thus, patients would present with accompanying conjunctival injection and tearing. However, there were more than 35 cases of neurovascular compression in our review.…”

An unusual case of short-lasting unilateral neuralgiform headache attacks

“…Neurovascular compression has been considered a distinguishing feature from trigeminal neuralgia, due to a reduced prevalence in SUNCT (5). Notwithstanding, there are some reports of trigeminal compression by vascular loops in SUNCT patients who went into remission after microvascular decompression surgery (6,7).…”

Microvascular decompression or neuromodulation in patients with SUNCT and trigeminal neurovascular conflict?

“…However, in a subset of patients with SUNHA and documented neurovascular conflict with the trigeminal nerve, 15 of 23 reported patients undergoing microvascular decompression (MVD) experienced complete resolution of pain (7,(16)(17)(18).…”