Trigeminal and occipital peripheral nerve stimulation for craniofacial pain: a single-institution experience and review of the literature

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Treatment of chronic neuropathic pain in the region of the head and face presents a challenge for pain specialists; patients who do not respond to conventional treatment modalities usually continue to suffer from pain due to the lack of reliable medical and surgical approaches. Peripheral nerve stimulation (PNS) has been used to treat neuropathic pain for many decades, but only recently has it been applied systematically to the craniofacial region. To advance the study of this treatment option, the authors present their initial experience with this approach, summarize published data on the use of PNS in treatment of craniofacial pain, and discuss some technical details of the craniofacial PNS procedure.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A review of prospectively collected data in 30 patients who underwent PNS surgery for craniofacial pain was performed. The pain location, duration, cause, and previous treatments were analyzed, along with the surgical details, initial and long-term results, complications, and repeated operations.</jats:p> <jats:p>Stimulated nerves in this group included supraorbital (seven patients), infraorbital (six), and occipital (21); in 19 patients more than one nerve was stimulated. Twenty-two patients proceeded with implantation of a permanent system after the trial. Of these, at the time of the latest evaluation (mean follow-up duration 35 months), in two patients the devices had been removed because of pain improvement over time, in three the devices were removed due to loss of effectiveness (two cases) or late infection (one), and the rest are enjoying either complete (15 patients) or partial (two patients) pain relief. Three patients underwent repeated operation due to lead erosion, infection, or migration.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Peripheral nerve stimulation appears to be a safe and effective approach in the treatment of craniofacial neuropathic pain. The growing body of literature supports a wider acceptance of this approach in the field of pain surgery.</jats:p></jats:sec>

Trigeminal branch stimulation for the treatment of intractable craniofacial pain

“…Consistent with prior reports, 6,11 we confirm that more than 70% of patients can expect to experience subjectively worthwhile pain relief with trigeminal stimulation. As with other pain-relieving modalities, loss of benefit over time is observed; however, long-term pain improvement can be seen in a significant subset of patients.…”

“…13 Over the next half century the use of peripheral nerve stimulation in the treatment of intractable facial pain has become increasingly reported. 1,6,7,[9][10][11][12] Significant advances in electrode construction, generator manufacturing, and surgical technique now allow for the permanent implantation of trigeminal branch electrodes by using minimally invasive methods. However, because very few practitioners routinely perform this procedure, the literature consists mainly of case reports and small case series.…”

Peripheral Nerve Stimulation for Neuropathic Pain

“…Location of this pocket is chosen based upon the patient's and surgeon's preference. Placement of the generator into the gluteal area, 49,50 abdominal wall, 38,44 or infraclavicular areas 34,45,47,48,51,55,58 has been described. In our opinion, the infraclavicular area (routinely used for placement of DBS generators) is the preferred location for both trigeminal and occipital nerve stimulation systems.…”

Treatment of Early Parkinson’s Disease

“…The effects of GDNF treatment in 2 open-label trials generated much optimism that this molecule might provide neuroprotection as well as restorative benefits [31, 32]; however, a double-blind trial was halted due to lack of efficacy and the development of antibodies to GDNF in 10% of patients [33]. In concurrent experiments, it was found that some non-human primates exhibited cerebellar degeneration following GDNF withdrawal [34].…”