Treatment of idiopathic headshaking with an injection of glycerol into the trigeminal ganglion in a 5 year old Warmblood mare

Uhlendorf, Frauke; Muller, Jean-Michel; Winter, J C; Feige, Karsten

doi:10.21836/pem20110602

Cited by 4 publications

(5 citation statements)

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“…Various treatments have been proposed, such as blinders (Madigan et al 1995), nose nets (Mair et al 1992, Mills et al 2002b, Mills and Taylor 2003, surgery (Mair 1999, Roberts et al 2009, Uhlendorf et al 2011, percutaneous electrical nerve stimulation (Roberts et al 2016), and medical treatment with cyproheptadine (Madigan and Bell 1998, Madigan and Bell 2001, Newton et al 2000, Madigan et al 1995, Mair 1999, Feige and Wehrli-Eser 1998, Bell 2004, carbamazepine (Newton et al 2000), cromoglycate (Mair et al 1992, Stalin et al 2008 or corticosteroids (Tomlinson et al 2013). Part of these treatments were, especially in seasonally affected horses, based on the suspicion of an allergic cause.…”

Section: Introductionmentioning

confidence: 99%

A randomized double blind placebo-controlled clinical trial of Cetirizine in horses affected by seasonal headshaking

Mesu¹,

Westermann²

2018

PHK

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Headshaking is a threat to the welfare of affected horses. As seasonal headshaking may be triggered by allergic conditions, this clinical trial investigated whether the second-generation antihistamine cetirizine decreased headshaking. The objective was to assess the clinical effect of cetirizine versus placebo on seasonal headshaking. The hypothesis was that it would reduce headshaking by 50 % in 50 % of the horses. Thirty client-owned horses with seasonal headshaking were selected on the basis of information from the owner and a general clinical examination. In this crossover randomised double-blind placebo-controlled clinical trial, horses were given cetirizine (0.4 mg/kg twice daily PO for 7 days) or placebo (same number of tablets twice daily PO for 7 days) in a randomised order, with a washout period of 1 week in between. A 9-minute lunge protocol was recorded on video at the start and after both treatment weeks, and the number of headshakes in this 9-minute period was scored by two assessors in a blinded manner. Data of 29 horses were analysed. The number of headshakes decreased by more than 50 % in 10 horses when they were given cetirizine and in 8 horses when they were given placebo. This difference was not significant (p = 0.73). In a mixed linear model incorporating weather conditions no significant treatment effect was found either. In conclusion: no significant effect of cetirizine on seasonal headshaking was found in the group of horses included in this study.

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Section: Introductionmentioning

confidence: 99%

A randomized double blind placebo-controlled clinical trial of Cetirizine in horses affected by seasonal headshaking

Mesu¹,

Westermann²

2018

PHK

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“…In the present study, the overall mean volume of the equine subarachnoid space within the trigeminal cave was 0.34 mL. In experimental and clinical studies reporting on glycerol rhizotomy procedures in horses, a volume of 1.6–1.9 mL of glycerol was injected ( 14 , 15 ). According to the results of the present study, this injected volume probably exceeds the capacity of the trigeminal cave in the horse.…”

Section: Discussionmentioning

confidence: 60%

“…Therefore, it remains unclear whether a CSF-filled trigeminal cistern exists and could be used as a target structure for glycerol rhizotomy in the horse. Nevertheless, percutaneous glycerol rhizotomies of the trigeminal ganglion have been attempted in horses, in an experimental setting and in clinical cases of trigeminal-mediated headshaking ( 14 , 15 ). These rhizotomy procedures were performed using computed tomography (CT)-guidance to inject the glycerol directly into the ganglionic tissue but gave rise to numerous complications, including bleeding and meningitis ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

“…Neither the report on the experimental work nor that of the clinical cases included contrast studies to determine the distribution pattern of the injected substances or detailed information about the targeted anatomical structures. Furthermore, the reports did not mention the possibility of targeting a CSF-filled trigeminal cistern, as it is described for the treatment of trigeminal neuralgia in humans ( 14 , 15 ).…”

Section: Introductionmentioning

confidence: 99%

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An anatomical study of the subarachnoid space surrounding the trigeminal ganglion in horses—in preparation for a controlled glycerol rhizotomy in equids

Becker,

Haenssgen,

Precht

et al. 2024

Front. Vet. Sci.

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IntroductionEquine trigeminal-mediated headshaking is a painful neuropathic disorder comparable to trigeminal neuralgia in humans. The selective destruction of pain fibers within the trigeminal ganglion, called rhizotomy, is the surgical treatment of choice for idiopathic trigeminal neuralgia refractory to medical treatment in humans. The human trigeminal ganglion is enclosed by a dural recess called the Meckel’s or trigeminal cave, in which the ganglion is surrounded by a cerebrospinal fluid (CSF)-filled subarachnoid space. During glycerol rhizotomy, glycerol is percutaneously injected in this CSF-filled space. Until now, information about the anatomy of the dural recess and the subarachnoid space surrounding the trigeminal ganglion is lacking in horses. The aim of this study was to explore if a CSF-filled subarachnoid space around the trigeminal ganglion exists in horses.Materials and methodsSix equine cadaver heads were investigated for CSF accumulation around the ganglion with a 3 Tesla MRI. After anatomical dissection to expose the trigeminal root, a polymer-based radiopaque contrast agent was injected through the porus trigeminus into the subarachnoid space (cisternography). The exact delineation and the volume of the contrast agent accumulation were determined on subsequent micro-computed tomographic scans and segmentation. Finally, the distribution of the contrast agent within the subarachnoid space was examined histologically in three specimens.ResultsIn all 12 specimens included in this study, the trigeminal ganglion was surrounded by a subarachnoid space forming a trigeminal cistern. The mean volume of the trigeminal cave in this study was 0.31 mL (±SD: 0.11 mL). Distribution of the contrast agent along the peripheral nerves (i.e., ophthalmic, maxillary and/or mandibular nerve) was observed in 7 out of 12 specimens.Discussion/conclusionA subarachnoid space surrounding the trigeminal ganglion exists in the horse and could be targeted for glycerol rhizotomy in horses suffering from trigeminal-mediated headshaking. However, the clinical relevance of contrast agent distribution along the peripheral nerves remains to be assessed.

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“…In neuester Zeit wird auch in der pferdemedizinischen Literatur über computertomographisch geführte Injektionstechniken im Bereich des Kopfes, der Halswirbelsäule und an der Gliedmassenspitze berichtet (Uhlendorf et al 2011, Mettenleiter und Köster 2012, Toth und Hollerrieder 2013. Nur eine Arbeit beschreibt die intraoperative Nutzung eines Computertomographen in vivo beim Pferd.…”

Section: Introductionunclassified

Interventional computer tomography – a new dimension in horse medicine – Part 1: CT assisted drilling and filling of subchondral cystic lesions in the horse

Mettenleiter¹

2014

PHK

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Interventional computer tomography -a new dimension in horse medicine -Part 1: CT assisted drilling and filling of subchondral cystic lesions in the horse The computed tomography is indispensable to secondary diagnostic in the head and neck area as well as on the limbs of the horse and is used routinely in specialized equine clinics. With this technique a super positional free representation of body parts is possible in different sectional levels and in three-dimensional images. The surgical treatment of subchondral cystic lesions (SCL) in the horse consists of surgical debridement and possibly in the replenishment of the cyst cavity in order to achieve revascularization and bone fusion of the damaged area. Depending on localization, shape and size of the cyst this is done via an arthroscopic or arthrotomic access. As an alternative to intraarticular surgical techniques the subchondral cystic lesions are classically treated by transcortical drilling via radiological control or fluoroscopy. These navigation methods, however, are severely limited due to the only two-dimensional imaging and the obtained information is often not satisfactory for the surgeon. The clinical use of CT-assisted surgical treatment of subchondral cystic lesions in horses (SCL with connection to the carpal joint, fetlock joint, pastern joint and navicular bursa) is shown by various examples. Via three-dimensional computed tomographic control, a gradual drilling of SCL was performed, afterwards the debridement of the cyst content, flushing and filling the cyst cavity and the drill hole. As a result, this surgical technique may also be referred as a sensible alternative to an arthroscopic or arthrotomic approach for difficult to access SCL in the joint region in horses. Further clinical studies are required in order to prove, to what extent the success rate actually improves in comparison to conventional techniques.

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Treatment of idiopathic headshaking with an injection of glycerol into the trigeminal ganglion in a 5 year old Warmblood mare

Cited by 4 publications

References 10 publications

A randomized double blind placebo-controlled clinical trial of Cetirizine in horses affected by seasonal headshaking

A randomized double blind placebo-controlled clinical trial of Cetirizine in horses affected by seasonal headshaking

An anatomical study of the subarachnoid space surrounding the trigeminal ganglion in horses—in preparation for a controlled glycerol rhizotomy in equids

Interventional computer tomography – a new dimension in horse medicine – Part 1: CT assisted drilling and filling of subchondral cystic lesions in the horse

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