Dural arteriovenous fistulas (dAVFs) account for 10–15% of all cerebral vascular malformations,1 and their location around the superior sagittal sinus is rare with an incidence of 4–11% of all dAVFs.2 Endovascular transarterial or transvenous embolization are the treatment routes of choice for dAVFs,3 but in rare cases direct sinus access may be favorable.4 5 We present an unusual case of a complex superior sagittal sinus dAVF with multiple arterial feeders and an occluded posterior superior sagittal sinus segment which was challenging for classic embolization routes. A combined surgical and endovascular approach in the hybrid biplane operating room was performed and is shown in video 1. By using a direct surgical burr hole for sinus access anterior to the dAVF and the thrombosed sinus portion followed by transvenous coil embolization, the dAVF was cured in a minimally invasive and safe fashion. Video 1 Treatment of a complex superior sagittal sinus dural arteriovenous fistula by surgical burr hole access for direct sinus puncture and transvenous coil embolization.:

Single-cell atlases provide valuable insights into gene expression states but lack information on cellular dynamics. Understanding cell turnover rates—the time between a cell’s birth and death—can shed light on stemness potential and susceptibility to damage. However, measuring turnover rates in human organs has been a significant challenge. In this study, we integrate transcriptomic data from both tissue and shed cells to assign turnover scores to individual cells, leveraging their expression profiles in spatially resolved expression atlases. By performing RNA sequencing on shed cells from the upper gastrointestinal tract, collected via nasogastric tubes, we infer turnover rates in the human esophagus, stomach, and small intestine. In addition, we analyze colonic fecal washes to map turnover patterns in the human large intestine. Our findings reveal a subset of short-lived, interferon-stimulated colonocytes within a distinct pro-inflammatory microenvironment. Our approach introduces a dynamic dimension to single-cell atlases, offering broad applicability across different organs and diseases.

Background: Trigeminal neuralgia (TN), a facial pain disorder classically characterized by recurrent brief electric-shock-like paroxysms in one or more trigeminal divisions, frequently traverses dental pathways before specialist evaluation. Conversely, dental extraction, endodontic treatment, implant procedures, and third-molar surgery may injure the inferior alveolar, superior alveolar, mental, or lingual nerves and generate painful post-traumatic trigeminal neuropathy. We sought to define the diagnostic interface between classical TN and post-dental/alveolar nerve-related trigeminal pain in a tertiary referral cohort. Methods: We performed a retrospective single-center diagnostic-pathway study using a clinical dataset comprising 672 unique patients. A dental-interface trigeminal candidate cohort was assembled from aggregated patient-level source notes and adjudicated into five prespecified phenotypes: confirmed alveolar neuropathy, post-extraction neuropathic onset, odontogenic diagnostic misclassification, mixed/uncertain dental-interface pain, and clean classical TN. Extracted variables included demographics, trigeminal branch documentation, sensory deficit, dental procedure history, post-extraction onset, MRI and neurovascular conflict language, secondary structural disease, TN-directed medication exposure, invasive treatment exposure, documented outcomes, and time from first specialist documentation to first dated invasive treatment. Results: Among 201 dental-interface trigeminal candidates, 19 patients (9.5%) had confirmed alveolar neuropathy, 31 (15.4%) had post-extraction neuropathic onset, 20 (10.0%) represented odontogenic diagnostic misclassification, 115 (57.2%) remained mixed/uncertain, and 16 (8.0%) fulfilled a clean classical TN phenotype. Overall, 114 patients (56.7%) carried explicit TN terminology somewhere in the chart. Non-classical alveolar/post-dental syndromes comprised 70 patients (34.8%). Compared with clean classical TN, this non-classical group had higher rates of documented oral sensory deficit (38.6% vs. 0.0%, p = 0.002), post-extraction onset (52.9% vs. 0.0%, p < 0.001), extraction history (61.4% vs. 0.0%, p < 0.001), and secondary structural disease (22.9% vs. 0.0%, p = 0.035). Neurovascular conflict or vascular-loop language did not distinguish non-classical alveolar/post-dental syndromes from clean classical TN (38.6% vs. 37.5%, p = 1.000). Conclusions: A substantial minority of tertiary dental-interface trigeminal referrals represented alveolar/post-dental syndromes rather than clean classical TN, even while carrying TN labels and accumulating TN-directed treatment exposure. Post-extraction onset, lower-lip/chin or intraoral sensory change, and pain persisting despite extraction should prompt careful phenotyping before classical TN-directed escalation. The alveolar–trigeminal interface can be operationalized as a recognizable diagnostic pathway with direct implications for multidisciplinary facial-pain evaluation.

Background: Burning Mouth Syndrome (BMS) is a chronic orofacial pain condition characterized by a burning sensation in the oral cavity without identifiable lesions. It predominantly affects women (especially postmenopausal) but can occur in men. BMS is considered a multifactorial neuropathic pain disorder involving both peripheral small-fiber neuropathy and central dysregulation, often accompanied by taste alterations (dysgusia) and xerostomia despite normal oral exams. Treatment is challenging, with modest responses to agents like clonazepam, tricyclic antidepressants, or gabapentinoids. Observations: We present a 67-year-old male with recalcitrant primary BMS who showed complete remission temporally associated with occipital nerve blockade, likely affecting central trigeminocervical pathways. Initial therapy with amitriptyline (25 mg) and gabapentin (900 mg/day) yielded ~30% pain relief. Given suspected central sensitization, greater and lesser occipital nerve (GON) blocks were administered in series. After the first, second, and third ON blocks, pain was reduced by ~50%, 80%, and 100%, respectively. Remission persisted at one-year follow-up under continued medications. A mild recurrence (~20% of baseline pain) responded fully to a fourth GON block, maintaining another year of pain-free status. Lessons: This case underscores the complex central mechanisms in BMS and illustrates that modulating central pain circuits via occipital nerve blockade, through trigeminocervical convergence mechanisms, without direct trigeminal intervention. We discuss the diagnostic challenges of BMS, the rationale of occipital neuromodulation, and how this novel therapeutic strategy compares with current literature, supporting the hypothesis of central sensitization in BMS.

BACKGROUND: Chronic migraine is a highly disabling neurological disorder. A subset of patients develop chronic daily headaches refractory to all standard therapies. MR-guided focused ultrasound (MRgFUS) ventral intermediate nucleus (VIM) thalamotomy is an incisionless treatment for medication-refractory essential tremor (ET). OBSERVATIONS: A 76-year-old woman with a 40-year history of chronic migraine with near-daily attacks, characterized predominantly by right-sided headaches and unresponsive to multiple preventive and acute treatments, underwent MRgFUS VIM thalamotomy for severe ET. After the procedure, her tremor resolved, and her chronic migraines were no longer reported during long-term follow-up. Shortly after the procedure, she developed burning mouth syndrome (BMS), characterized by bilateral oral burning dysesthesias with left-sided predominance involving the lips and oral mucosa. She was treated with gabapentin and amitriptyline, with partial symptomatic improvement. Postprocedure MRI confirmed the intended VIM lesion with slight medial extension toward the adjacent ventral posteromedial nucleus (VPM) of the thalamus, which relays trigeminal somatosensory input. LESSONS: This unique case illustrates that ablative neuromodulation of thalamic networks may be followed by marked improvement or remission of chronic refractory migraine, further supporting a possible role for the thalamus in migraine pathophysiology and pain transmission. It also highlights a potential trade-off: lesion extension toward nearby sensory nuclei, including the VPM, may be associated with focal central pain manifesting as BMS. https://thejns.org/doi/10.3171/CASE251040