Johnson Mark D, Burchiel Kim J
Department of Neurological Surgery, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA.
Neurosurgery. 2004 Jul;55(1):135-41; discussion 141-2.
Trigeminal neuropathic pain (TNP) after facial trauma or herpes zoster infection is often refractory to treatment. Peripheral nerve stimulation has been used to treat occipital neuralgia; however, efficacy in controlling facial TNP or postherpetic neuralgia is unknown. A retrospective case series of patients who underwent subcutaneous placement of stimulating electrodes for treatment of V(1) or V(2) TNP secondary to herpetic infection or facial trauma is presented.
Ten patients received implanted subcutaneous pulse generators and quadripolar electrodes for peripheral stimulation of the trigeminal nerve supraorbital or infraorbital branches. Long-term treatment results were determined by retrospective review of medical records (1998-2003) and by independent observers interviewing patients using a standard questionnaire. Surgical complication rate, preoperative symptom duration, degree of pain relief, preoperative and postoperative work status, postoperative changes in medication usage, and overall degree of therapy satisfaction were assessed. Mean follow-up was 26.6 +/- 4.7 months.
Peripheral nerve stimulation provided at least 50% pain relief in 70% of patients with TNP or postherpetic neuralgia. Medication use declined in 70% of patients, and 80% indicated that they were mostly or completely satisfied with treatment overall. There were no treatment failures (<50% pain relief and a lack of decrease in medication use) in the posttraumatic group, and two failures (50%) occurred in the postherpetic group. The complication rate requiring reoperation was 30%.
Peripheral nerve stimulation of the supraorbital or infraorbital branches of the trigeminal nerve is an effective method for relief of TNP after facial trauma or herpetic infection. A prospective trial using this novel approach to treat these disorders is thus warranted.
面部创伤或带状疱疹感染后的三叉神经痛（TNP）通常对治疗具有难治性。外周神经刺激已被用于治疗枕神经痛；然而，其在控制面部TNP或带状疱疹后神经痛方面的疗效尚不清楚。本文呈现了一组回顾性病例系列，这些患者接受了皮下植入刺激电极以治疗继发于疱疹感染或面部创伤的V（1）或V（2）TNP。
10名患者接受了植入式皮下脉冲发生器和四极电极，用于对三叉神经眶上或眶下分支进行外周刺激。通过回顾医疗记录（1998 - 2003年）以及独立观察者使用标准问卷对患者进行访谈来确定长期治疗结果。评估手术并发症发生率、术前症状持续时间、疼痛缓解程度、术前和术后工作状态、术后用药变化以及总体治疗满意度。平均随访时间为26.6±4.7个月。
外周神经刺激使70%的TNP或带状疱疹后神经痛患者疼痛缓解至少50%。70%的患者用药量减少，80%的患者表示他们对总体治疗基本或完全满意。创伤后组无治疗失败病例（疼痛缓解<50%且用药量未减少），疱疹后组有2例失败病例（50%）。需要再次手术的并发症发生率为30%。
对三叉神经眶上或眶下分支进行外周神经刺激是缓解面部创伤或疱疹感染后TNP的有效方法。因此有必要进行一项前瞻性试验，采用这种新方法来治疗这些疾病。
