Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA.
J Neurosurg. 2011 Jan;114(1):189-95. doi: 10.3171/2010.5.JNS091696. Epub 2010 May 28.
Neuropathic facial pain can be a debilitating condition characterized by stabbing, burning, dysesthetic sensation. With a large range of causes and types, including deafferentation, postherpetic, atypical, and idiopathic, both medicine and neurosurgery have struggled to find effective treatments that address this broad spectrum of facial pain. The authors report the use of motor cortex stimulation to alleviate 3 distinct conditions associated with intractable facial pain: trigeminal deafferentation pain following rhizotomy, deafferentation pain secondary to meningioma, and postherpetic neuralgia. Functional MR imaging was used to localize facial areas on the precentral gyrus prior to surgery. All 3 patients experienced long-lasting complete or near-complete resolution of pain following electrode implantation. Efficacy in pain reduction was achieved through variation of stimulation settings over the course of treatment, and it was assessed using the visual analog scale and narrative report. Surgical complications included moderate postsurgical incisional pain, transient cerebral edema, and intraoperative seizure. The authors' results affirm the efficacy and broaden the application of motor cortex stimulation to several forms of intractable facial pain.
神经性面痛是一种使人衰弱的疾病，其特征为刺痛、烧灼感、感觉异常。这种疾病有多种病因和类型，包括去传入性、疱疹后、非典型和特发性，因此，药物和神经外科都在努力寻找针对这种广泛面部疼痛的有效治疗方法。作者报告了使用运动皮层刺激来缓解与难治性面部疼痛相关的 3 种不同情况：神经根切断术后三叉神经去传入性疼痛、脑膜瘤引起的去传入性疼痛和疱疹后神经痛。手术前使用功能磁共振成像在中央前回上定位面部区域。所有 3 名患者在电极植入后均经历了持久的完全或近乎完全的疼痛缓解。通过在治疗过程中改变刺激设置来实现疼痛减轻的效果，并使用视觉模拟量表和叙述性报告进行评估。手术并发症包括中度术后切口疼痛、短暂性脑水肿和术中癫痫发作。作者的结果证实了运动皮层刺激的疗效，并将其应用范围扩大到多种难治性面部疼痛。
