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Microvascular decompression of the trigeminal nerve in the treatment of SUNCT and SUNA
  1. Max Williams1,
  2. Renata Bazina2,
  3. Leong Tan2,
  4. Hal Rice3,
  5. Simon A Broadley1,4
  1. 1Department of Neurology, Gold Coast Hospital, Southport, Australia
  2. 2Department of Neurosurgery, Gold Coast Hospital, Southport, Australia
  3. 3Department of Medical Imaging, Gold Coast Hospital, Southport, Australia
  4. 4School of Medicine, Gold Coast Campus, Griffith University, Australia
  1. Correspondence to Dr Max Williams, Department of Neurology, Gold Coast Hospital, 108 Nerang Street, Southport Q 4215, Australia; maxhw{at}


Background Medical management of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) syndrome and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) is often unsatisfactory.

Methods The authors report nine cases of SUNCT/SUNA that failed medical treatment and had an aberrant arterial loop either in contact with or compressing the appropriate trigeminal nerve demonstrated on MRI. All underwent microvascular decompression of the ipsilateral trigeminal nerve for intractable pain.

Results Immediate and complete relief of SUNCT and SUNA symptoms occurred in 6/9 (67%) cases. This was sustained for a follow-up period of 9–32 months (mean 22.2). In 3/9 (33%) cases, there was no benefit. Ipsilateral hearing loss was observed in one case.

Conclusion Medically intractable SUNCT and SUNA subjects with a demonstrable aberrant arterial loop impinging on the trigeminal nerve on neuroimaging may benefit from microvascular decompression.

  • SUNA
  • trigeminal neuralgia
  • microvascular decompression
  • treatment
  • autonomic
  • headache
  • neurosurgery
  • trigeminal nerve

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Gold Coast Hospital HREC.

  • Provenance and peer review Not commissioned; externally peer reviewed.