C1-C3 unilateral dorsal root entry zone rhizotomy for the treatment of persistent postherpetic occipital neuralgia
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky.
DOI:10.25259/SNI_520_2019Copyright: © 2019 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Zaid Aljuboori, Joseph Neimat. C1-C3 unilateral dorsal root entry zone rhizotomy for the treatment of persistent postherpetic occipital neuralgia. 01-Nov-2019;10:214
How to cite this URL: Zaid Aljuboori, Joseph Neimat. C1-C3 unilateral dorsal root entry zone rhizotomy for the treatment of persistent postherpetic occipital neuralgia. 01-Nov-2019;10:214. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=9730
Background: Postherpetic occipital neuralgia (PHON) is a neuropathic pain condition that usually presents as paroxysmal pain that is stabbing in nature.[
Case Description: A 37-year-old female had a history of several episodes of shingles involving the left neck and occiput; they resolved after treatment with valacyclovir. Subsequently, however, she developed severe lancinating pain of the neck and the occiput and was diagnosed with PHON. Initially, she was treated with oxcarbazepine but was stopped due to cognitive side effects. She then had a cervical spinal cord stimulator implanted which produced relief for several years; it was later removed due to breakage of the electrodes. She then underwent a left- sided C1-C2 hemilaminectomy with a C1-C3 DREZ procedure.[
Conclusion: Although high cervical DREZ lesions may effectively treat post herpetic/occipital neuralgia that fails other measures, there may be associated major neurological morbidity that makes this procedure acceptable as a salvage option, and after clearly explaining the risks to the patient.
Keywords: Dorsal root, Herpes zoster, Neuralgia, Pain, Rhizotomy
Multimedia 1: A
1. Harke H, Gretenkort P, Ladleif HU, Koester P, Rahman S. Spinal cord stimulation in postherpetic neuralgia and in acute herpes zoster pain. Anesth Analg. 2002. 94: 694-700
2. Johnson RW, Rice AS. Postherpetic neuralgia. N Engl J Med. 2014. 371: 1526-33
3. Keep MF, DeMare PA, Ashby LS. Gamma knife surgery for refractory postherpetic trigeminal neuralgia: Targeting in one session both the retrogasserian trigeminal nerve and the centromedian nucleus of the thalamus. J Neurosurg. 2005. 102: 276-82
4. Kost RG, Straus SE. Postherpetic neuralgia pathogenesis, treatment, and prevention. N Engl J Med. 1996. 335: 32-42
5. Sampathkumar P, Drage LA, Martin DP. Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clin Proc. 2009. 84: 274-80
6. Texakalidis P, Tora MS, Boulis NM. Neurosurgeons’ armamentarium for the management of refractory postherpetic neuralgia: A systematic literature review. Stereotact Funct Neurosurg. 2019. 97: 55-65
7. Wall PD. Neuropathic pain and injured nerve: Central mechanisms. Br Med Bull. 1991. 47: 631-43