Percutaneous Trigeminal Stimulation for Intractable Facial Pain: A Case Series

Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S10-S10
Author(s):  
Pavlos Texakalidis ◽  
Muhibullah S Tora ◽  
J Tanner McMahon ◽  
Alexander Greven ◽  
Casey L Anthony ◽  
...  
Keyword(s):  
Facial Pain ◽  
Case Series ◽  
Trigeminal Stimulation

Percutaneous Trigeminal Stimulation for Intractable Facial Pain: A Case Series

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. 547-554 ◽  
Author(s):  
Pavlos Texakalidis ◽  
Muhibullah S Tora ◽  
J Tanner McMahon ◽  
Alexander Greven ◽  
Casey L Anthony ◽  
...  
Keyword(s):  
Head Trauma ◽  
Facial Pain ◽  
Rating Scale ◽  
Oral Surgery ◽  
Treatment Options ◽  
Case Series ◽  
Lead Contamination ◽  
Complication Rates ◽  
Trial Period ◽  
Trigeminal Stimulation

Abstract BACKGROUND Facial 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. OBJECTIVE To report the complication rates and analgesic effects associated with TG stimulation and identify potential predictors for these outcomes. METHODS A 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. RESULTS Successful 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. CONCLUSION TG 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.

Styloid-stylohyoid syndrome: a rare cause of cranio-facial pain—a retrospective case series of 12 patients

2018 ◽  
Vol 23 (1) ◽  
pp. 47-51
Author(s):  
Anson Jose ◽  
Saurabh Arya ◽  
Shakil Ahmed Nagori ◽  
Indranil Deb Roy ◽  
Omesh Tokas
Keyword(s):  
Facial Pain ◽  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series

scholarly journals Peripheral Nerve Stimulation for Trigeminal Neuropathic Pain

2012 ◽  
Vol 1;15 (1;1) ◽  
pp. 27-33 ◽  
Author(s):  
David A. Stidd
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Medical Management ◽  
Facial Pain ◽  
Case Series ◽  
Peripheral Nerve Stimulation ◽  
Intractable Pain ◽  
Safe Procedure ◽  
Trigeminal Neuropathic Pain

Facial pain is a complex disease with a number of possible etiologies. Trigeminal neuropathic pain (TNP) is defined as pain caused by a lesion or disease of the trigeminal branch of the peripheral nervous system resulting in chronic facial pain over the distribution of the injured nerve. First line treatment of TNP includes management with anticonvulsant medication (carbamazepine, phenytoin, gabapentin, etc.), baclofen, and analgesics. TNP, however, can be a condition difficult to adequately treat with medical management alone. Patients with TNP can suffer from significant morbidity as a result of inadequate treatment or the side effects of pharmacologic therapy. TNP refractory to medical management can be considered for treatment with a growing number of invasive procedures. Peripheral nerve stimulation (PNS) is a minimally invasive option that has been shown to effectively treat medically intractable TNP. We present a case series of common causes of TNP successfully treated with PNS with up to a 2 year follow-up. Only one patient required implantation of new electrode leads secondary to electrode migration. The patients in this case series continue to have significant symptomatic relief, demonstrating PNS as an effective treatment option for intractable TNP. Though there are no randomized trials, peripheral neuromodulation has been shown to be an effective means of treating TNP refractory to medical management in a growing number of case series. PNS is a safe procedure that can be performed even on patients that are not optimal surgical candidates and should be considered for patients suffering from TNP that have failed medical management. Key words: Trigeminal neuropathic pain, peripheral nerve stimulation, neuromodulation, intractable pain, facial trauma, postherpetic neuralgia

scholarly journals Ultrasound-Guided Trigeminal Nerve Block via the Pterygopalatine Fossa: An Effective Treatment for Trigeminal Neuralgia and Atypical Facial Pain

2013 ◽  
Vol 5;16 (5;9) ◽  
pp. E537-E545
Author(s):  
Mark C. Kendall
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Nerve Block ◽  
Trigeminal Nerve ◽  
Local Anesthetic ◽  
Facial Pain ◽  
Case Series ◽  
Pterygopalatine Fossa ◽  
Atypical Facial Pain ◽  
Ultrasound Guided

Background: Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminal nerve block via the pterygopalatine fossa in patients following refractory medical and surgical treatment. Objective: To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the pterygopalatine fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions. Setting: Academic pain management center. Design: Prospective case series. Methods: Fifteen patients were treated with ultrasound-guided trigeminal nerve block with local anesthetic and steroids placed into the pterygopalatine fossa. Results: All patients achieved complete sensory analgesia to pin prick in the distribution of the V2 branch of the trigeminal nerve and 80% (12 out of 15) achieved complete sensory analgesia in V1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within 5 minutes of the injection. The majority of patients maintained pain relief throughout the 15 month study period. No patients experienced symptoms of local anesthetic toxicity or onset of new neurological sequelae. Limitations: Prospective case series. Conclusion: We conclude that the use of ultrasound guidance for injectate delivery in the pterygopalatine fossa is a simple, free of radiation or magnetization, safe, and effective percutaneous procedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patients who have failed previous medical interventions. Key words: Trigeminal nerve, ultrasound-guided, atypical facial pain, trigeminal neuralgia, tic douloureux.

scholarly journals 119 Case Series: Outcomes in Peripheral Nerve Stimulation for Medically Refractory Atypical Facial Pain

Neurosurgery ◽  
2018 ◽  
Vol 65 (CN_suppl_1) ◽  
pp. 87-87
Author(s):  
James T McMahon ◽  
Muhibullah S Tora ◽  
J. Nicole Bentley ◽  
Melissa A Campbell ◽  
Orion P Keifer ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Facial Pain ◽  
Case Series ◽  
Peripheral Nerve Stimulation ◽  
Atypical Facial Pain

scholarly journals Case Series: Cancer-Related Facial Pain Treated with Stellate Ganglion Block

2020 ◽  
Vol 1 (1) ◽  
pp. 290-295
Author(s):  
Raheleh Rahimi Darabad ◽  
Jerry P. Kalangara ◽  
Anna Woodbury
Keyword(s):  
Facial Pain ◽  
Stellate Ganglion ◽  
Case Series ◽  
Stellate Ganglion Block ◽  
Ganglion Block

Case Series: Deep Brain Stimulation for Facial Pain

2020 ◽  
Vol 19 (5) ◽  
pp. 510-517
Author(s):  
Alon Kashanian ◽  
Jasmine A T DiCesare ◽  
Pratik Rohatgi ◽  
Luigi Albano ◽  
Scott E Krahl ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Facial Pain ◽  
Case Series ◽  
Atypical Facial Pain ◽  
Average Decrease ◽  
Pain Scores ◽  
Post Traumatic ◽  
Removal Of Hardware ◽  
Deep Brain

Abstract BACKGROUND Deep brain stimulation (DBS) has been used for chronic pain for decades, but its use is limited due to a lack of reliable data about its efficacy for specific indications. OBJECTIVE To report on 9 patients who underwent DBS for facial pain, with a focus on differences in outcomes between distinct etiologies. METHODS We retrospectively reviewed 9 patients with facial pain who were treated with DBS of the ventral posteromedial nucleus of the thalamus and periventricular gray. We report on characteristics including facial pain etiology, complications, changes in pain scores using the visual analog scale (VAS), and willingness to undergo DBS again. RESULTS Nine patients underwent DBS for either poststroke, post-traumatic, postherpetic, or atypical facial pain. Eight patients (89%) were permanently implanted. Seven patients had sufficient follow-up (mean 40.3 mo). Of these 7 patients, average VAS scores decreased from 9.4 to 6.1 after DBS. The average decrease in VAS was 55% for post-traumatic facial pain (2 patients), 45% for poststroke (2 patients), 15% for postherpetic neuralgia (2 patients), and 0% for atypical facial pain (1 patient). Three of the 8 implanted patients (38%) had complications which required removal of hardware. Only 2 of 7 (29%) patients met classical criteria for responders (50% decrease in pain scores). However, among 4 patients who were asked about willingness to undergo DBS again, all expressed that they would repeat the procedure. CONCLUSION There is a trend towards improvement in pain scores following DBS for facial pain, most prominently with post-traumatic pain.

Application of the capsaicin 8% cutaneous patch in neuropathic pain of the head and face: A case series

Cephalalgia ◽  
2014 ◽  
Vol 35 (6) ◽  
pp. 545-550 ◽  
Author(s):  
Charly Gaul ◽  
Sonja Resch
Keyword(s):  
Neuropathic Pain ◽  
Facial Pain ◽  
Case Series ◽  
Additional Treatment ◽  
Line Treatment ◽  
First Line ◽  
Head Region ◽  
Affected Area ◽  
Pain Syndromes ◽  
First Line Treatment

Introduction Treatment of neuropathic or neuralgic head and facial pain due to dental, traumatic or surgical nerve lesions or post-herpetic neuropathy is often challenging. Cases We are reporting on four patients with neuropathic pain syndromes successfully treated with a capsaicin 8% patch in the affected area of the head or face. Discussion Treatment with the capsaicin 8% patch seems to be effective and safe for application to the facial and head region. The capsaicin 8% patch might be an additional treatment option if first-line treatment with anticonvulsants or antidepressants was ineffective or limited by side effects.

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