Andrei Brinzeu

Microvascular decompression has been shown in multiple long-term series to provide durable pain freedom in 75–95% of patients with classical trigeminal neuralgia, defined as neuralgia related to an identified neurovascular conflict, frequently arterial. Surgical success relies on an effective decompression, achieved by displacing the offending arteries while avoiding neo-compression(s) by implanted material. The procedure is performed through a keyhole retrosigmoid (retromastoid) craniectomy, using an infratentorial, supracerebellar corridor to the trigeminal root that minimizes traction on the facial–vestibulocochlear complex. In this video, we demonstrate the step-by-step technique as applied in patients in whom high-resolution MRI demonstrated the conflict preoperatively.

Somatosensory mismatch negativity (sMMN) constitutes an electrophysiological marker that initially reflects preattentional processing and subsequently indexes automatic somatosensory deviance detection. While its application in adult populations is gradually expanding, the establishment of a standardized and reproducible methodology for eliciting and analyzing sMMN in pediatric populations remains uncertain. To determine whether the published literature provides a clear, consistent, and standardized methodology for sMMN assessment in individuals under 18 years. A search was conducted in PubMed (11), Scopus (6), Web of Science (6), DOAJ (1), Europe PMC (6), Embase (0), ClinicalKey (0), Cochrane Library (0) and ClinicalTrials.gov (0) database from inception to 18 August 2025. Eligible studies included research assessing sMMN using somatosensory oddball paradigms in participants <18 years. Inclusion criteria (participants younger than 18 years, the use of the oddball paradigm to evaluate somatosensory mismatch negativity, and clinical reports, single-case reports or experimental studies including both typically developing children and children with neurological conditions, published in English), and exclusion criteria (exclusivity for adult participants, and narrative reviews or editorials) were defined a priori, as well as the screening procedures and quality assessment methods. Two reviewers independently performed study selection and data extraction, with a third reviewer resolving disagreements. Risk of bias was assessed using the MMAT (mixed methods appraisal tool). Due to substantial heterogeneity in paradigms and outcome reporting, results were synthesized narratively. Four studies met inclusion criteria. Methodological diversity was pronounced across everything except task type that was passive. There is not a consensus regarding stimulation parameters. Risk of bias assessment revealed frequent concerns related to incomplete reporting and variability in analytic choices. The small number of studies, inconsistent methodological reporting, and absence of harmonized protocols limited comparability. Current evidence does not support the existence of a standardized methodology for assessing sMMN in children. Future studies should adopt harmonized stimulation paradigms and transparent, reproducible reporting standards to enable cross-study comparability and clinical translation.

Background/Objectives: Open anterolateral cordotomy (OALC) is a surgical intervention that has been performed to treat patients with persistent pain for more than a century. In recent decades, its application has been reduced in favor of other less invasive treatments. The present article aims to define indications, safety, and the efficacy profile of this procedure for the contemporary neurosurgeon. Methods: A systematic review of articles published from 2010 to 2025 has been performed. Only patients who underwent OALC for cancer pain were included. Results: Eleven articles were included in the systematic review for a total of 33 patients. Adequate pain response was obtained in 87.9% of cases. In 21.2% of patients, some kind of complication was reported, but they persisted only in three patients (9%). A single case of mirror pain was described. Conclusions: OALC is a procedure still performed in selected cases of persistent cancer pain with a favorable safety and efficacy profile.

When a neurovascular conflict is demonstrated on high-resolution MRI in patients with drug-refractory Vago-Glossopharyngeal neuralgia microvascular decompression is regarded as the most effective therapeutic option. The aim of surgery is to relieve the conflict, most often produced by the posterior inferior cerebellar artery, not infrequently in association with a compressive megadolicho-vertebrobasilar artery. This can be safely achieved by exposure of the Vago-Glossopharyngeal nerve complex through a retromastoid-retrosigmoid infrafloccular approach through the cisterna magna, allowing exposure the lateral medulla and root entry zone of the lower cranial nerves. This report provides our step-by-step recommended technique for optimal efficacy and safety.

Central neuropathic pain resulting from spinal cord injury is notoriously debilitating and difficult to treat with few currently available treatments. A novel molecule with intrathecal administration: Ziconotide has been approved for treatment of refractory neuropathic pain in general. It acts as a presynaptic calcium channel blocker. A pilot study has shown its potential in SCI neuropathic pain patients. The aim of this study is to determine the long-term (6 months) efficacy of chronic intrathecal ziconotide for the treatment of neuropathic SCI pain. Multicenter, Randomized, Comparative, Placebo controlled, Double blind clinical trial, with a crossover of random alternated periods of 6 months (placebo or ITZ) for a total of 15 months including a total of 44 patients. • Patients with SCI of various etiologies exhibiting neuropathic pain refractory to non-invasive treatments. • > 18 years. Intrathecal administration of ziconotide via an implanted pump. Primary study outcome Difference in pain intensity for all patients between effective treatment and placebo periods. Secondary study outcomes 1. Continuous evaluation of pain intensity. 2. Percentage of patients with at least 30% of pain reduction. 3. Satisfaction level of the patient pain relief. 4. Declarations of serious adverse events. 5. Duration and intensity of spontaneous and provoked pain. 6. Quality of life. 7. Patient global impression of change. 8. Quantification of daily dosages of analgesic drug intake. 9. Long term memory and neurocognitive effects. 10. Assessment of the patient’s physical and emotional distress. Participation in this study is in accordance with current treatment protocols for SCI neuropathic pain in France therefore it proposes a treatment that would currently be considered regular practice even though no RCT evidence is yet available. The study gives patients the advantage of directly testing versus placebo a treatment that otherwise entails significant constraints. A Data Safety Monitoring board (DSMB) will be created for continuous safety analysis. Furthermore, patients will be followed in specialized pain centers offering the possibility of continuing their treatment after the study period.

Based on a personal experience of 4200 surgeries, radiofrequency thermocoagulation is useful lesional treatment for those trigeminal neuralgias (TNs) not amenable to microvascular decompression (idiopathic or secondary TNs). Introduced through the foramen ovale, behind the trigemnial ganglion in the triangular plexus, the needle is navigated by radiology and neurophysiological testing to target the retrogasserian fibers corresponding to the trigger zone. Heating to 55–75 °C can achieve hypoesthesia without anaesthesia dolorosa if properly controlled. Depth of anaesthesia varies dynamically sedation for cannulation and lesioning, and awareness during neurophysiologic navigation. Proper technique ensures long-lasting results in more than 75% of patients.