The Duke Experience with Nucleus Caudalis DREZ Coagulation

Abstract

The results of 46 nucleus caudalis DREZ coagulations performed at Duke in the preceding 5 years are reviewed retrospectively, with a mean follow-up of 32 months. Fifteen (38%) of 39 patients with complete data indicated that they would undergo the procedure again. Fifteen (38%) described improved quality of life. Outcome was fair or better in 18 (46%). Complications in the form of ataxia were present in 21 (54%).

Staged bilateral nucleus caudalis drez lesioning for persistent idiopathic facial pain: exceptional case report

“…Neurosurgical procedures like nucleus caudalis DREZ lesioning should be considered as valuable options when the classic treatments fail to reduce pain. There are reports in the literature of response to nucleus caudalis DREZ lesioning in the treatment of anesthesia dolorosa, postherpetic neuralgia, cerebral infarction, PIFP, multiple sclerosis, pain secondary to head trauma, craniofacial surgery, and neoplasm (3)(4)(5)14,25,26,28,29). Gorecki et al (14) reported limited response to the operation among PIFP patients and a small number of patients that maintained their pain-free status in the long-term.…”

“…Gorecki et al (14) reported limited response to the operation among PIFP patients and a small number of patients that maintained their pain-free status in the long-term. Nashold et al reported that less than one-fourth of patients remained pain-free one year after the operation (14,27). Sindou et al concluded that paroxysmal shooting pain was significantly more responsive to the procedure than pain described as a continuous burning sensation (41,42).…”

“…DREZ lesions in general are not expected to affect sensation to touch or trigeminal motor function, but ataxia, usually transient, was found to be the most common complication (14). Maximum attention should be given in cases with bilateral facial pain.…”

Nucleus Caudalis Dorsal Root Entry Zone Lesions: A Clinical-Radiographic Case Report

“…Within the nucleus caudalis, medial regions of the face are represented rostrally while peripheral regions are represented caudally in a conformation known as the 'onionpeel' pattern. There is also a specific alignment of fibers from the three divisions of the trigeminal throughout its course [20] . The close proximity of these three structures to the nucleus caudalis poses significant risk during surgical procedures involving the nucleus ( fig.…”

Posterior Occipital Approach in Deep Brain Stimulation for Both Pain and Involuntary Movement

“…We considered this involuntary movement to be the so-called 'hyperkinésies volitionelles' [9,10] Taira/Kawamura/Takakura an arm dysfunction is documented as a complication of this operation [11]. Because stereotactic thalamotomy is known to relieve such hyperkinetic involuntary movement [10] and the patient also suffered intractable deafferentation pain, we decided to try stimulation therapy from an occipital burr hole.…”