Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
Division of Neurosurgery, University of British Columbia, Vancouver, Canada.
Oper Neurosurg (Hagerstown). 2021 Jul 15;21(2):81-86. doi: 10.1093/ons/opab136.
Neuropathic dental pain (NDP) is a chronic pain condition that is notoriously difficult to treat. To date, there are no deep brain stimulation (DBS) studies on this specific pain condition and no optimal target or "sweet spot" has ever been defined.
To determine the optimal thalamic target for improving this condition by utilizing the steering abilities of a directional DBS electrode (Vercise CartesiaTM Model DB-2202-45, Boston Scientific).
A literature search and review of our database identified 3 potential thalamic targets. A directional lead was implanted in a patient with NDP and its current steering used to test the effects in each nucleus. The patient reported her pain after 2 wk of stimulation in a prospective randomized blinded trial of one. Quality of life measurements were performed before and after 3 mo on their best setting.
We identified 3 potential nuclei: the centromedian (CM), ventral posterior medial (VPM), and anterior pulvinar. The best results were during VPM stimulation (>90% reduction in pain) and CM stimulation (50% reduction). Following 3 mo of VPM-DBS in combination of lateral CM stimulation, their pain disability index dropped (from 25 to 0) and short form 36 improved (from 67.5 to 90).
VPM stimulation in combination with CM stimulation is a promising target for NDP. DBS electrode directionality can be used to test multiple targets and select a patient specific "sweet spot" for NDP treatment.
神经性牙痛（NDP）是一种慢性疼痛疾病，治疗难度极大。迄今为止，针对这种特定的疼痛疾病尚无深部脑刺激（DBS）研究，也从未定义过最佳目标或“最佳刺激点”。
通过利用定向 DBS 电极（Vercise CartesiaTM Model DB-2202-45，Boston Scientific）的导向能力，确定改善这种疾病的最佳丘脑目标。
文献检索和数据库回顾确定了 3 个潜在的丘脑靶点。将定向导联植入一位患有 NDP 的患者体内，并利用其电流导向测试每个核团的效果。在一项为期 2 周的单侧定向随机盲法试验中，患者报告了刺激后的疼痛情况。在最佳设置 3 个月后，进行生活质量测量。
我们确定了 3 个潜在的核团：中央核（CM）、腹后内侧核（VPM）和前丘脑核。VPM 刺激（疼痛减轻>90%）和 CM 刺激（疼痛减轻 50%）的效果最好。在 VPM-DBS 联合外侧 CM 刺激 3 个月后，他们的疼痛残疾指数下降（从 25 降至 0），36 项简短健康调查量表（SF-36）评分提高（从 67.5 升至 90）。
VPM 刺激联合 CM 刺激是治疗 NDP 的一种有前途的靶点。DBS 电极的方向性可用于测试多个靶点，并为 NDP 治疗选择患者特异性的“最佳刺激点”。
