微小血管減圧術が奏効した結膜充血と流涙を伴う難治性の短時間持続性片側神経痛様頭痛発作（SUNCT）の1例

Effective Microvascular Decompression of the Trigeminal Nerve in a Patient with SUNCT

43歳男性。右眼周囲の電撃痛で発症。4カ月後に同部位に充血，流涙，鼻漏を伴う1時間程度の鋸歯状の激痛が出現し，結膜充血と流涙を伴う短時間持続性片側神経痛様頭痛発作（SUNCT）と診断。診断の2カ月後に改善したが，6カ月後に再発した。ラモトリギンなど多くの抗てんかん薬に対して中毒疹がみられ，難治性と考えられた。頭部MRIで右三叉神経に神経血管圧迫（NVC）がみられ，微小血管減圧術（MVD）を施行。術後より痛みは寛解した。一部のSUNCTにはNVCの関与も推測され，難治例にはMVDの検討も必要である。

Abstract

A 43-year-old man presented with severe, saw-tooth pattern pain around the right eye that started with conjunctival injection, lacrimation and nasal discharge, lasting for about 1 hour, 4 months after the initial onset of lancinating pain in the same area. The patient was diagnosed with SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) according to the International Classification of Headache Disorders 3rd edition (beta version). The symptoms improved in 2 months but recurred 6 months later. He developed a toxic eruption after receiving a variety of antiepileptic agents including lamotrigine, which suggested refractory SUNCT. Head magnetic resonance imaging (MRI) showed neurovascular compression (NVC) involving the right trigeminal nerve. Microvascular decompression (MVD) was performed, and the pain was relieved postoperatively. MVD should be considered when treating refractory SUNCT because NVC may be involved in some cases.

(Received February 29, 2016; Accepted April 4, 2016; Published August 1, 2016)