• Pavlos Texakalidis, Muhibullah S Tora, J Tanner McMahon, Alexander Greven, Casey L Anthony, Purva Nagarajan, Melissa Campbell, and Nicholas M Boulis.
• Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia.
• Neurosurgery. 2020 Sep 1; 87 (3): 547-554.

BackgroundFacial pain syndromes can be refractory to medical management and often need neurosurgical interventions. Neuromodulation techniques, including percutaneous trigeminal ganglion (TG) stimulation, are reversible and have emerged as alternative treatment options for intractable facial pain.ObjectiveTo report the complication rates and analgesic effects associated with TG stimulation and identify potential predictors for these outcomes.MethodsA retrospective chart review of 59 patients with refractory facial pain who underwent TG stimulation was conducted. Outcomes following trial period and permanent stimulation were analyzed. Patients with >50% pain relief during trial stimulation received permanent implantation of the stimulation system.ResultsSuccessful trial stimulation was endorsed by 71.2% of patients. During the trial period, 1 TG lead erosion was identified. History of trauma (facial/head trauma and oral surgery) was the only predictor of a failed trial compared to pain of idiopathic etiology (odds ratio: 0.15; 95% CI: 0.03-0.66). Following permanent implantation, approximately 29.6% and 26.5% of patients were diagnosed with lead erosion and infection of the hardware, respectively. TG lead migrations occurred in 11.7% of the patients. The numeric rating scale score showed a statistically significant reduction of 2.49 (95% CI: 1.37-3.61; P = .0001) at an average of 10.8 mo following permanent implantation.ConclusionTG stimulation is a feasible neuromodulatory approach for the treatment of intractable facial pain. Facial/head trauma and oral surgery may predict a nonsuccessful trial stimulation. Future development of specifically designed electrodes for stimulation of the TG, and solutions to reduce lead contamination are needed to mitigate the relatively high complication rate.Copyright © 2020 by the Congress of Neurological Surgeons.

23 keywords...

hide…