Abstract
Introduction. The literature showed a limited number of cases of facial pain caused by pathology at the level of the craniovertebral junction, however there is no a single case of pain caused by the migration of elements of the shunt systems.The objective is to describe a clinical case of successful surgical treatment of facial pain caused by the Torkildsen shunt migration.Clinical case. A female patient, 58 years old, applied to the clinic complaining of constant pain with a paroxysmal component in the left part of the face and back of the skull associated with head movements. Other complaints included a headache accompanied by nausea, numbness in the limbs, instability in vertical position, urinary incontinence, abnormal proprioceptive sensitivity in the limbs. Medical history showed that in 2000 the patient underwent Torkildsen procedure (ventriculo-cisternostomy) due to occlusive hydrocephalus after a neurological infection. In 2013, due to shunt dysfunction endoscopic third ventriculostomy was performed with a good clinical effect. Deterioration started in January of 2018. At hospitalization, tomography of the brain showed migration of the distal end of the shunt into spinal matter, syringobulbia at the C1 vertebra level. No signs of neurovascular conflict of the trifacial nerves were observed. Removal of the ventriculo-cisternal shunt irritating the spinal nucleus of the trifacial nerve was performed. In the postoperative period, intensity of the paroxysmal component of facial pain decreased. At day 5 after surgery, the patient was discharged in a satisfactory state. For 1 year and 6 months after the surgery, facial pain has been absent. Manifestations of hydrocephalus and spinal disorder (numbness of the limbs, instability, urinary incontinence) persist, but due to the patient’s compensated state, negative result of the tap-test, signs of functional third ventriculostomy, it was decided to abstain from further interventions.Conclusion. This clinical case demonstrated successful treatment of facial pain developed due to a rare cause – migration of a Torkildsen shunt that currently is rarely encountered.
Highlights
The literature showed a limited number of cases of facial pain caused by pathology at the level of the craniovertebral junction, there is no a single case of pain caused by the migration of elements of the shunt systems
The objective is to describe a clinical case of successful surgical treatment of facial pain caused by the Torkildsen shunt migration
Необходимо помнить, что причиной развития лицевой боли у пациентов с шунтом, установленным по методу Торкильдсена, может быть миграция шунта в вещество спинного мозга на уровне шейного отдела
Summary
Цель работы – описание клинического случая успешного хирургического лечения лицевой боли, которую вызвала миграция шунта, установленного в ходе операции Торкильдсена. У пациентки была проведена вентрикулоцистерностомия по Торкильдсену по поводу окклюзионной гидроцефалии после перенесенной нейроинфекции. На протяжении 1 года 6 мес после операции лицевая боль отсутствует. Проявления гидроцефалии и поражения спинного мозга (онемение конечностей, неустойчивость, недержание мочи) сохраняются, однако ввиду компенсированного состояния пациентки, отрицательного результата tap-теста, наличия признаков функционирующей тривентрикулостомы от дальнейших вмешательств решено воздержаться. Данный клинический случай демонстрирует успешное лечение лицевой боли, развившейся по редкой причине – вследствие миграции почти не встречающегося в настоящее время шунта, установленного по методу Торкильдсена. Ключевые слова: вентрикулоцистерностомия по Торкильдсену, операция Торкильдсена, шунт, сирингобульбия, лицевая боль, спинальное ядро тройничного нерва. А. Лицевая боль вследствие миграции шунта, установленного по методу Торкильдсена. Zelman Institute for Medicine and Psychology, Novosibirsk State University; 1 Pirogova St., Novosibirsk 630090, Russia
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