Floridia Daniela, Cerra Francesco, Corallo Francesco, Di Cara Marcella, Spartà Salvatore, Nania Giovanni, Bramanti Alessia, Bramanti Placido, Naro Antonino
Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino-Pulejo, Messina, Italy.
Medicine (Baltimore). 2020 Oct 2;99(40):e22304. doi: 10.1097/MD.0000000000022304.
Treatment of chronic neuropathic pain in the head and face regions presents a challenge for pain specialists due to the lack of reliable medical and surgical approaches.
A 62-year-old patient came to our attention for an intense facial pain secondary to a lesion of the right trigeminal nerve (all branches) due to a petroclival meningioma.
The patient also presented with gait impairment as well as a deficit of the right facial, auditory, trochlear and abducens cranial nerves.
Conventional medical management (CMM) as well as tonic SCS were already adopted but they all dramatically failed. We intervened with the use of high-frequency (10 kHz) spinal cord stimulation (HFSCS) at the cervicomedullary junction (CMJ). The patient was thus provided with HFSCS at the CMJ. Pain and quality of life (QoL) were assessed 1 and 3 months after implantation. We also tested the trigeminal-facial reflex responses.
HFSCS led to a full relief from the debilitating electric shocks like pain in the right hemiface, even though a background dull pain appeared. The gradual addition of pregabalin helped in fully relieving the painful symptomatology, with a significant improvement in QoL. Moreover, sensitivity amelioration on the inner portion of the mouth allowed the patient to start feeding again also using that side of the mouth. These findings were paralleled by a significant reshape of trigeminal-facial reflex responses suggesting an inhibition of nociceptive sensory inputs at brainstem level following HFSCS.
This is the first report suggesting the usefulness of HFSCS at the CMJ in neuropathic pain due to trigeminal nerve neuropathy non-responsive to tonic SCS and CMM.
由于缺乏可靠的医学和外科治疗方法，治疗头面部区域的慢性神经性疼痛对疼痛专家来说是一项挑战。
一名62岁患者因岩斜区脑膜瘤导致右侧三叉神经（所有分支）损伤，出现剧烈面部疼痛，引起了我们的关注。
患者还存在步态障碍以及右侧面部、听觉、滑车和展神经功能缺损。
已经采用了传统医学管理（CMM）以及强直性脊髓刺激（SCS），但均以显著失败告终。我们在颈髓交界处（CMJ）采用高频（10kHz）脊髓刺激（HFSCS）进行干预。因此，为该患者在CMJ处实施了HFSCS。在植入后1个月和3个月评估疼痛和生活质量（QoL）。我们还测试了三叉神经-面部反射反应。
HFSCS使右侧半面部令人衰弱的电击样疼痛完全缓解，尽管出现了背景性钝痛。逐渐加用普瑞巴林有助于完全缓解疼痛症状，QoL有显著改善。此外，口腔内部感觉改善使患者能够再次开始使用口腔的该侧进食。这些发现与三叉神经-面部反射反应的显著重塑同时出现，表明HFSCS后在脑干水平抑制了伤害性感觉输入。
这是第一份表明在CMJ处进行HFSCS对因三叉神经病变导致的神经性疼痛（对强直性SCS和CMM无反应）有用的报告。
