Craniofacial postherpetic neuralgia managed by stereotactic spinal trigeminal nucleotomy

Postherpetic craniofacial neuralgias are notoriously difficult to deal with. Nevertheless, stereotactic spinal trigeminal nucleotomy seems to be a rational approach, as both experimental and clinical data strongly suggest the relevance of nucleus caudalis for certain facial neurogenic pain phenomena. From a series of 136 consecutive nucleotomies, 80 were performed for deafferentation pain. The long-term results of 25 such cases, who underwent this procedure for postherpetic neuralgia, are reported. Their pain was referred to the Vth, to the VII, IX and Xth, and to the C2-3 dermatomes. Abolition of the allodynia, and disappearance of, or marked reduction in, the deep background pain was achieved in 76% of the cases overall. The follow-up period ranged from 1 to 13 years. There was no untoward side-effects. Technical and electrophysiological data germane to accurate target placement are discussed. Spinal trigeminal nucleotomy is then a specially suitable procedure for postherpetic craniofacial dysaesthesiae.