Persistent headache after craniotomy for meningioma: charting of the afferent pathways for nociception: a discussion

Abstract

Most intracranial space-occupying lesions require surgical resolution through excision. This intervention could lead to significant sequelae such as pain, either due to the scar or the persistence of residue from the injury, among others. Trigeminal neuralgia is a condition that generates great limitations in the quality of life of patients who suffer from it. With the study of this pathology, it has become clear that understanding the trigeminal-cervical convergence is essential to successfully approach an optimal therapeutic plan. Having a clear and exhaustive knowledge of the neuroanatomical substrates involved in the transmission of pain from trigeminal neuralgia, we present a clinical case evaluated in our Pain Unit. This is a patient with trigeminal headache that is disabling for daily life and resistant to multiple therapeutic options that, in addition, limited the alternatives for its control due to the persistence of tumor remnants despite the attempt at complete resection during surgery. In this clinical case, we have considered various therapeutic targets that can be addressed through interventional techniques that are increasingly used in Pain Units. Taking into account the pain pathway compromised in this case, we have even gone so far as to surgically address central anatomical structures responsible for pain control to improve the patient’s quality of life.