{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T04:58:06Z","timestamp":1770353886164,"version":"3.49.0"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"21","license":[{"start":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T00:00:00Z","timestamp":1684713600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,22]]},"abstract":"\n BACKGROUND<\/jats:title>\n Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a rare headache disorder that has been associated with pituitary adenomas. Resection has been posited to be curative.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 60-year-old female presented with a 10-year history of SUNCT, which had been medically refractory. Sellar magnetic resonance imaging (MRI) showed a 2 \u00d7 2 mm nodule in the right anterolateral aspect of the pituitary. Endoscopic endonasal transsphenoidal resection of the pituitary microadenoma with neuronavigation was performed. The patient felt immediate relief from the headaches. Postoperative MRI showed persistence of the pituitary microadenoma and the resection tract to be inferomedial to the lesion. The right middle and partial superior turbinectomy site was close to the sphenopalatine foramen (SPF). The patient was discharged on postoperative day 1 and remained headache-free without any medications at the 4-month follow-up.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Resection of pituitary lesions associated with SUNCT may not necessarily be the cause of SUNCT resolution. Manipulation of the middle and superior turbinate close to the SPF may lead to a pterygopalatine ganglion block. This may be the mechanism of cure for SUNCT in patients with related pituitary lesions who undergo endonasal resection.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case23119","type":"journal-article","created":{"date-parts":[[2023,5,23]],"date-time":"2023-05-23T09:18:34Z","timestamp":1684833514000},"source":"Crossref","is-referenced-by-count":1,"title":["Missed pituitary microadenoma during endoscopic transsphenoidal surgery for short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing with symptom relief: illustrative case"],"prefix":"10.3171","volume":"5","author":[{"given":"Juan Silvestre G.","family":"Pascual","sequence":"first","affiliation":[{"name":"Department of Clinical Neurosciences, Division of Neurosurgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madeleine","family":"de Lotbiniere-Bassett","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, Division of Neurosurgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katrina Hannah D.","family":"Ignacio","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, Division of Neurology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Ben-Israel","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, Division of Neurosurgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica M.","family":"Clark","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Otolaryngology Head and Neck Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yves P.","family":"Starreveld","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, Division of Neurosurgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Cephalalgia","first-page":"147","article-title":"Shortlasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, sweating, and rhinorrhea","volume":"9","author":"Sjaastad O","year":"1989","unstructured":"Sjaastad O, Saunte C, Salvesen R, Shortlasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, sweating, and rhinorrhea. Cephalalgia. 1989;9(2):147\u2013156.2743414"},{"issue":"1","key":"b2","series-title":"Cephalalgia","first-page":"1","article-title":"Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders","volume":"38","year":"2018","unstructured":"Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders. 3rd edition. Cephalalgia. 2018;38(1):1\u2013211.29368949"},{"issue":"3","key":"b3","series-title":"Cephalalgia","first-page":"160","article-title":"SUNCT, SUNA and pituitary tumors: clinical characteristics and treatment","volume":"33","author":"Chitsantikul P","year":"2013","unstructured":"Chitsantikul P, Becker WJ. SUNCT, SUNA and pituitary tumors: clinical characteristics and treatment. Cephalalgia. 2013;33(3):160\u2013170.23197348"},{"issue":"8","key":"b4","series-title":"Lancet Neurol","first-page":"755","article-title":"Pathophysiology of trigeminal autonomic cephalalgias","volume":"8","author":"Leone M","year":"2009","unstructured":"Leone M, Bussone G. Pathophysiology of trigeminal autonomic cephalalgias. Lancet Neurol. 2009;8(8):755\u2013764.19608101"},{"issue":"9","key":"b5","series-title":"Brain Sci","first-page":"1252","article-title":"SUNCT\/SUNA in pediatric age: a review of pathophysiology and therapeutic options","volume":"11","author":"Cesaroni CA","year":"2021","unstructured":"Cesaroni CA, Pruccoli J, Bergonzini L, SUNCT\/SUNA in pediatric age: a review of pathophysiology and therapeutic options. Brain Sci. 2021;11(9):1252.34573272"},{"issue":"12","key":"b6","series-title":"Curr Treat Options Neurol","first-page":"42","article-title":"Treatment of SUNCT\/SUNA, paroxysmal hemicrania, and hemicrania continua: an update including single-arm meta-analyses","volume":"22","author":"Stubberud A","year":"2020","unstructured":"Stubberud A, Tronvik E, Matharu M. Treatment of SUNCT\/SUNA, paroxysmal hemicrania, and hemicrania continua: an update including single-arm meta-analyses. Curr Treat Options Neurol. 2020; 22(12):42."},{"issue":"2","key":"b7","series-title":"J Headache Pain","first-page":"114","article-title":"SUNCT and high nocturnal prolactin levels: some new unusual characteristics","volume":"8","author":"Bosco D","year":"2007","unstructured":"Bosco D, Labate A, Mungari P, Vero S, Fava A. SUNCT and high nocturnal prolactin levels: some new unusual characteristics. J Headache Pain. 2007;8(2):114\u2013118.17497264"},{"issue":"5","key":"b8","series-title":"J Clin Endocrinol Metab","first-page":"1789","article-title":"The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas","volume":"85","author":"Arafah BM","year":"2000","unstructured":"Arafah BM, Prunty D, Ybarra J, Hlavin ML, Selman WR. The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas. J Clin Endocrinol Metab. 2000;85(5):1789\u20131793.10843153"},{"issue":"1","key":"b9","series-title":"Cephalalgia","first-page":"76","article-title":"SUNCT syndrome in a patient with prolactinoma and cabergoline-induced attacks","volume":"27","author":"Jim\u00e9nez Caballero PE","year":"2007","unstructured":"Jim\u00e9nez Caballero PE. SUNCT syndrome in a patient with prolactinoma and cabergoline-induced attacks. Cephalalgia. 2007;27(1):76\u201378."},{"issue":"1","key":"b10","series-title":"J Neurosurg","first-page":"123","article-title":"Short-lasting, unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome treated successfully with transsphenoidal resection of a growth hormone-secreting pituitary adenoma","volume":"109","author":"Adamo MA","year":"2008","unstructured":"Adamo MA, Drazin D, Popp AJ. Short-lasting, unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome treated successfully with transsphenoidal resection of a growth hormone-secreting pituitary adenoma. J Neurosurg. 2008;109(1):123\u2013125.18590441"},{"key":"b11","series-title":"J Laryngol Otol","first-page":"S47","article-title":"Sphenopalatine foramen: endoscopic approach with bony landmarks","volume":"129","author":"Nalavenkata S","year":"2015","unstructured":"Nalavenkata S, Meller C, Novakovic D, Forer M, Patel NP. Sphenopalatine foramen: endoscopic approach with bony landmarks. J Laryngol Otol. 2015;129(suppl 3):S47\u2013S52.25816928"},{"issue":"9-10","key":"b12","series-title":"Ideggyogy Sz","first-page":"345","article-title":"Acute effect of sphenopalatine ganglion block with lidocaine in a patient with SUNCT","volume":"73","author":"Kocat\u00fcrk M","year":"2020","unstructured":"Kocat\u00fcrk M, Kocat\u00fcrk \u00d6. Acute effect of sphenopalatine ganglion block with lidocaine in a patient with SUNCT. Ideggyogy Sz. 2020; 73(9-10):345\u2013348."},{"issue":"1","key":"b13","series-title":"J Headache Pain","first-page":"118","article-title":"Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation: a systematic review","volume":"18","author":"Ho KWD","year":"2017","unstructured":"Ho KWD, Przkora R, Kumar S. Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation: a systematic review. J Headache Pain. 2017;18(1):118.29285576"},{"issue":"5","key":"b14","series-title":"Headache","first-page":"938","article-title":"Sphenopalatine ganglion pulsed radiofrequency for the treatment of refractory chronic SUNCT and SUNA: a prospective case series","volume":"60","author":"Ornello R","year":"2020","unstructured":"Ornello R, Palmisani S, Murphy M, Sacco S, Al-Kaisy A, Lambru G. Sphenopalatine ganglion pulsed radiofrequency for the treatment of refractory chronic SUNCT and SUNA: a prospective case series. Headache. 2020;60(5):938\u2013945."},{"key":"b15","series-title":"World Neurosurg","first-page":"167","article-title":"Gamma knife radiosurgery for short unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome: targeting the trigeminal nerve and the sphenopalatine ganglion. Case report and literature review","volume":"133","author":"Zaed I","year":"2020","unstructured":"Zaed I, Attuati L, Tommasino C, Gamma knife radiosurgery for short unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome: targeting the trigeminal nerve and the sphenopalatine ganglion. Case report and literature review. World Neurosurg. 2020;133:167\u2013171.31606507"},{"issue":"2","key":"b1","series-title":"Cephalalgia","first-page":"147","article-title":"Shortlasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, sweating, and rhinorrhea","volume":"9","author":"Sjaastad O","year":"1989","unstructured":"Sjaastad O, Saunte C, Salvesen R, Shortlasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, sweating, and rhinorrhea. Cephalalgia. 1989;9(2):147\u2013156.2743414"},{"issue":"1","key":"b2","series-title":"Cephalalgia","first-page":"1","article-title":"Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders","volume":"38","year":"2018","unstructured":"Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders. 3rd edition. Cephalalgia. 2018;38(1):1\u2013211.29368949"},{"issue":"3","key":"b3","series-title":"Cephalalgia","first-page":"160","article-title":"SUNCT, SUNA and pituitary tumors: clinical characteristics and treatment","volume":"33","author":"Chitsantikul P","year":"2013","unstructured":"Chitsantikul P, Becker WJ. SUNCT, SUNA and pituitary tumors: clinical characteristics and treatment. Cephalalgia. 2013;33(3):160\u2013170.23197348"},{"issue":"8","key":"b4","series-title":"Lancet Neurol","first-page":"755","article-title":"Pathophysiology of trigeminal autonomic cephalalgias","volume":"8","author":"Leone M","year":"2009","unstructured":"Leone M, Bussone G. Pathophysiology of trigeminal autonomic cephalalgias. Lancet Neurol. 2009;8(8):755\u2013764.19608101"},{"issue":"9","key":"b5","series-title":"Brain Sci","first-page":"1252","article-title":"SUNCT\/SUNA in pediatric age: a review of pathophysiology and therapeutic options","volume":"11","author":"Cesaroni CA","year":"2021","unstructured":"Cesaroni CA, Pruccoli J, Bergonzini L, SUNCT\/SUNA in pediatric age: a review of pathophysiology and therapeutic options. Brain Sci. 2021;11(9):1252.34573272"},{"issue":"12","key":"b6","series-title":"Curr Treat Options Neurol","first-page":"42","article-title":"Treatment of SUNCT\/SUNA, paroxysmal hemicrania, and hemicrania continua: an update including single-arm meta-analyses","volume":"22","author":"Stubberud A","year":"2020","unstructured":"Stubberud A, Tronvik E, Matharu M. Treatment of SUNCT\/SUNA, paroxysmal hemicrania, and hemicrania continua: an update including single-arm meta-analyses. Curr Treat Options Neurol. 2020; 22(12):42."},{"issue":"2","key":"b7","series-title":"J Headache Pain","first-page":"114","article-title":"SUNCT and high nocturnal prolactin levels: some new unusual characteristics","volume":"8","author":"Bosco D","year":"2007","unstructured":"Bosco D, Labate A, Mungari P, Vero S, Fava A. SUNCT and high nocturnal prolactin levels: some new unusual characteristics. J Headache Pain. 2007;8(2):114\u2013118.17497264"},{"issue":"5","key":"b8","series-title":"J Clin Endocrinol Metab","first-page":"1789","article-title":"The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas","volume":"85","author":"Arafah BM","year":"2000","unstructured":"Arafah BM, Prunty D, Ybarra J, Hlavin ML, Selman WR. The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas. J Clin Endocrinol Metab. 2000;85(5):1789\u20131793.10843153"},{"issue":"1","key":"b9","series-title":"Cephalalgia","first-page":"76","article-title":"SUNCT syndrome in a patient with prolactinoma and cabergoline-induced attacks","volume":"27","author":"Jim\u00e9nez Caballero PE","year":"2007","unstructured":"Jim\u00e9nez Caballero PE. SUNCT syndrome in a patient with prolactinoma and cabergoline-induced attacks. Cephalalgia. 2007;27(1):76\u201378."},{"issue":"1","key":"b10","series-title":"J Neurosurg","first-page":"123","article-title":"Short-lasting, unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome treated successfully with transsphenoidal resection of a growth hormone-secreting pituitary adenoma","volume":"109","author":"Adamo MA","year":"2008","unstructured":"Adamo MA, Drazin D, Popp AJ. Short-lasting, unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome treated successfully with transsphenoidal resection of a growth hormone-secreting pituitary adenoma. J Neurosurg. 2008;109(1):123\u2013125.18590441"},{"key":"b11","series-title":"J Laryngol Otol","first-page":"S47","article-title":"Sphenopalatine foramen: endoscopic approach with bony landmarks","volume":"129","author":"Nalavenkata S","year":"2015","unstructured":"Nalavenkata S, Meller C, Novakovic D, Forer M, Patel NP. Sphenopalatine foramen: endoscopic approach with bony landmarks. J Laryngol Otol. 2015;129(suppl 3):S47\u2013S52.25816928"},{"issue":"9-10","key":"b12","series-title":"Ideggyogy Sz","first-page":"345","article-title":"Acute effect of sphenopalatine ganglion block with lidocaine in a patient with SUNCT","volume":"73","author":"Kocat\u00fcrk M","year":"2020","unstructured":"Kocat\u00fcrk M, Kocat\u00fcrk \u00d6. Acute effect of sphenopalatine ganglion block with lidocaine in a patient with SUNCT. Ideggyogy Sz. 2020; 73(9-10):345\u2013348."},{"issue":"1","key":"b13","series-title":"J Headache Pain","first-page":"118","article-title":"Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation: a systematic review","volume":"18","author":"Ho KWD","year":"2017","unstructured":"Ho KWD, Przkora R, Kumar S. Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation: a systematic review. J Headache Pain. 2017;18(1):118.29285576"},{"issue":"5","key":"b14","series-title":"Headache","first-page":"938","article-title":"Sphenopalatine ganglion pulsed radiofrequency for the treatment of refractory chronic SUNCT and SUNA: a prospective case series","volume":"60","author":"Ornello R","year":"2020","unstructured":"Ornello R, Palmisani S, Murphy M, Sacco S, Al-Kaisy A, Lambru G. Sphenopalatine ganglion pulsed radiofrequency for the treatment of refractory chronic SUNCT and SUNA: a prospective case series. Headache. 2020;60(5):938\u2013945."},{"key":"b15","series-title":"World Neurosurg","first-page":"167","article-title":"Gamma knife radiosurgery for short unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome: targeting the trigeminal nerve and the sphenopalatine ganglion. Case report and literature review","volume":"133","author":"Zaed I","year":"2020","unstructured":"Zaed I, Attuati L, Tommasino C, Gamma knife radiosurgery for short unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome: targeting the trigeminal nerve and the sphenopalatine ganglion. Case report and literature review. World Neurosurg. 2020;133:167\u2013171.31606507"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/5\/21\/article-CASE23119.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/5\/21\/article-CASE23119.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/5\/21\/article-CASE23119.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T14:31:03Z","timestamp":1770301863000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/5\/21\/article-CASE23119.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,22]]},"references-count":30,"journal-issue":{"issue":"21"},"URL":"https:\/\/doi.org\/10.3171\/case23119","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,22]]}}}