Gritsenko, Karina

Introduction Trigeminal neuralgia is a debilitating facial pain condition characterized by recurrent, electric shock-like episodes within the trigeminal nerve distribution. While first-line treatment involves pharmacologic therapy, treatment options are limited for patients who are refractory or poor surgical candidates. Case Presentation We present a 75-year-old female with long-standing idiopathic trigeminal neuralgia refractory to combination anticonvulsant therapy and nerve block, with notable medication-related side effects. Management and Outcomes The patient underwent percutaneous cryoneurolysis targeting the maxillary (V2) and mandibular (V3) divisions of the trigeminal nerve under fluoroscopic guidance. She experienced immediate pain reduction and complete symptom resolution at a one-month follow-up with no complications. Conclusion This case highlights percutaneous cryoneurolysis as a minimally invasive treatment option for selected patients with refractory trigeminal neuralgia who are not candidates for open surgical intervention.

Introduction Craniofacial hyperplasia is a disorder where the face and head do not fully develop. This leads to difficulties in airway management in those undergoing general anesthesia (GA), requiring consideration in anesthetic planning with GA and intubation versus approaches with regional/spinal anesthesia. Case Presentation A 54-year-old male (45 kg, 172.7 cm) presented for a penile implant insertion for severe erectile dysfunction following radical prostatectomy. He was classified as ASA physical status class III. Management and Outcomes Pertinent medical history included craniofacial hypoplasia from childhood surgical interventions and radiation for sinus cancer (rhabdomyosarcoma), moderate mitral regurgitation, mild tricuspid regurgitation, pulmonary hypertension, recurrent esophageal strictures, and anemia. Spinal anesthesia was selected over GA. Airway complications were avoided, and cardiopulmonary stability was preserved while maintaining adequate analgesic coverage. Conclusion Craniofacial hypoplasia patients require individualized anesthesia planning that anticipates complications. Spinal anesthesia can be used in these patients to avoid airway and hemodynamic complications.