Department of Neurological Surgery, Emory University Hospital, Atlanta, GA, USA.
Department of Neurological Surgery, Indiana University Health, Indianapolis, IN, USA.
Neuromodulation. 2021 Aug;24(6):1100-1106. doi: 10.1111/ner.13306. Epub 2020 Nov 3.
Atypical facial pain syndromes are challenging disorders to manage and often incur limited benefit with surgery for classical trigeminal neuralgia presentations, such as microvascular decompression or ablative procedures. Neurostimulation of the trigeminal ganglion and peripheral nerves can be effective at treating atypical presentations of trigeminal facial pain affecting the V1-3 dermatomes, and the surgical techniques are well described. The stimulation parameters, however, have thus far received limited description; we therefore sought to describe programming strategies.
We performed a retrospective chart review, examining patients that underwent trigeminal ganglion stimulation (TGS) and nerve branch stimulation for atypical facial pain and trigeminal neuropathic pain, and describe the programming strategies in detail.
We describe the use of high-frequency stimulation (1000 Hz), with alteration in pulse width (60-220 msec) and amplitude (0.5-3 V) to achieve effective treatment of refractory trigeminal facial pain. These parameters differ from existing published parameters for trigeminal nerve branch stimulation. We also describe the programming of specific contacts on each lead to target specific aspects of the individual patients' facial pain.
The use of effective programming strategies is critical to the success of neurostimulation surgical treatments; however, the critical details in programming strategies typically receive limited description. We report on the use of several successful programming strategies for TGS, to assist pain providers in successfully applying these surgical techniques in these difficult to manage atypical facial pain syndromes.
非典型面痛综合征的治疗颇具挑战，对于经典三叉神经痛表现（如微血管减压或消融术），手术往往获益有限。三叉神经节和外周神经的神经刺激在治疗影响 V1-3 皮节的非典型三叉面部疼痛方面非常有效，且手术技术已有详细描述。然而，刺激参数的描述却很有限；因此，我们旨在描述编程策略。
我们进行了一项回顾性图表审查，研究了接受三叉神经节刺激（TGS）和神经分支刺激治疗非典型面部疼痛和三叉神经病理性疼痛的患者，并详细描述了编程策略。
我们描述了使用高频刺激（1000 Hz），并改变脉冲宽度（60-220 msec）和幅度（0.5-3 V），以实现对难治性三叉面部疼痛的有效治疗。这些参数与现有的三叉神经分支刺激发布参数不同。我们还描述了在每个导联上对特定触点进行编程，以针对患者个体面部疼痛的特定方面进行靶向治疗。
有效的编程策略对于神经刺激手术治疗的成功至关重要；然而，编程策略中的关键细节通常描述有限。我们报告了 TGS 的几种成功编程策略的使用，以帮助疼痛提供者在这些难以治疗的非典型面痛综合征中成功应用这些手术技术。
