Keifer Orion P, Zeising Kate, Tora Muhibullah S, Campbell Melissa, Bezchlibnyk Yarema B, Boulis Nicholas
Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA.
World Neurosurg. 2019 Feb;122:308-310. doi: 10.1016/j.wneu.2018.11.034. Epub 2018 Nov 14.
Trigeminal ganglion stimulation can be effective for trigeminal neuralgia. For patients who respond well to neurostimulation delivered percutaneously through the foramen ovale but require extensive revision and removal of instrumentation, a subtemporal approach for stimulation of the trigeminal ganglion is an alternative option as a salvage procedure.
We report on a 47-year-old woman who responded well to neurostimulation for trigeminal neuropathic pain over a 1-year period from 2008 to 2009. Her preoperative pain on the numerical rating scale (NRS) was between 7 and 8 out of 10, which decreased to 2 out of 10 postoperatively. However, she developed lead migration because of a motor vehicle accident. After revision surgeries to correct this, she continued to experience pain relief until 2011. At follow-up, signs of infection prompted removal of instrumentation and subsequent return of her pain. She continued to experience persistent and severe pain (NRS score 7 of 10), which was intractable to pharmacologic treatment over 5 years. She returned in 2016 to discuss neurosurgical options, and the original approach was ruled out because of her history of lead migration, erosion, and scarring. A subtemporal approach was pursued as a salvage option, which provided several advantages for this patient.
The subtemporal approach for salvage placement of the trigeminal ganglion stimulating electrode was effective in this patient and minimized risks given her history of erosion and multiple operations. This suggests that the subtemporal approach is a viable salvage operation for trigeminal ganglion stimulation for trigeminal neuropathic pain.
三叉神经节刺激术对三叉神经痛可能有效。对于经卵圆孔经皮给予神经刺激反应良好但需要广泛翻修和移除器械的患者，颞下进路刺激三叉神经节作为挽救手术是一种替代选择。
我们报告一名47岁女性，她在2008年至2009年的1年时间里对三叉神经病理性疼痛的神经刺激反应良好。她术前数字评分量表（NRS）的疼痛评分在7至8分（满分10分）之间，术后降至2分。然而，由于一场机动车事故，她出现了电极移位。在进行翻修手术后，她持续疼痛缓解直至2011年。随访时，感染迹象促使移除器械，随后疼痛复发。她持续经历持续且严重的疼痛（NRS评分为7分，满分10分），在5年多的时间里药物治疗难以控制。她于2016年回来讨论神经外科手术方案，由于她有电极移位、侵蚀和瘢痕形成的病史，原手术入路被排除。作为挽救方案，采用了颞下进路，这为该患者带来了诸多益处。
颞下进路用于挽救性放置三叉神经节刺激电极对该患者有效，并鉴于她的侵蚀和多次手术病史将风险降至最低。这表明颞下进路是用于三叉神经病理性疼痛的三叉神经节刺激术的一种可行的挽救手术。
