Trigeminal branch stimulation for the treatment of intractable craniofacial pain

Abstract

OBJECT Trigeminal branch stimulation has been used in the treatment of craniofacial pain syndromes. The risks and benefits of such an approach have not been clearly delineated in large studies, however. The authors report their experience in treating craniofacial pain with trigeminal branch stimulation and share the lessons they have learned after 93 consecutive electrode placements. METHODS A retrospective review of all patients who underwent trigeminal branch electrode placement by the senior author (C.J.W.) for the treatment of craniofacial pain was performed. RESULTS Thirty-five patients underwent implantation of a total of 93 trial and permanent electrodes between 2006 and 2013. Fifteen patients who experienced improved pain control after trial stimulation underwent implantation of permanent stimulators and were followed for an average of 15 months. At last follow-up 73% of patients had improvement in pain control, whereas only 27% of patients had no pain improvement. No serious complications were seen during the course of this study. CONCLUSIONS Trigeminal branch stimulation is a safe and effective treatment for a subset of patients with intractable craniofacial pain.

Subcutaneous trigeminal nerve field stimulation for refractory trigeminal pain: a cohort analysis

“…With respect to 'pain intensity' as outcome measure, a strong treatment response (70-100 % of pain reduction) was achieved in five of the six patients receiving permanent implantation. Altogether, the efficacy rate of our patients is similar to previously published data [1,6,11,18,20] . However, in addition to previous reports, we focused not only on 'pain intensity' but also 'attack frequency' as outcome measures.…”

“…Notably, two patients were able to end an attack by increasing the voltage via their hand-held controller. Compared to the literature, reporting on 41-62 % of patients being provided with a permanent implantation and 17-40 % of revision surgeries [1,6,11,18,20], the rate of permanent implantation was higher (75 %) and side effects similar to previous reports. The surgical procedure used in our patients is comparable to the surgical approach of previous case series [11].…”

Peripheral Nerve Stimulation for Refractory Trigeminal Pain: Recent Single-Institution Case Series With Long-Term Follow-Up and Review of the Literature

“…In these studies, the efficacy of PNS ranges from 50 to 100% of patients reporting greater than 50% pain reduction, with average follow‐up of 21.4 months. The largest number of patients with permanent trigeminal implants previously reported to date is by Ellis et al, with 15 permanently implanted patients, 11 of whom had trigeminal facial pain syndromes .…”

Burst or Conventional Peripheral Nerve Field Stimulation for Treatment of Neuropathic Facial Pain

“…Where all these measures are ineffective, or where medication causes intolerable side-effects, neuromodulation may be an option. Stimulation has been applied at a range of sites, including peripherally using subcutaneous electrodes in the face (2)(3)(4)(5)(6)(7)(8)(9), at the Gasserian ganglion (10)(11)(12), and centrally with high cervical spinal cord stimulation (targeting the spinal trigeminal nucleus) (13)(14)(15), deep brain stimulation (16) (targeting the ventroposteromedial nucleus of the thalamus and/or the periaqueductal gray matter), or motor cortex stimulation (17)(18)(19).…”