Gupta Kunal
Department of Neurosurgery, Indiana University, Indianapolis, IN, United States.
Stark Neuroscience Research Institute, Indiana University, Indianapolis, IN, United States.
Front Pain Res (Lausanne). 2022 Mar 17;3:835471. doi: 10.3389/fpain.2022.835471. eCollection 2022.
Trigeminal ganglion stimulation is a neuromodulatory surgical procedure utilized to treat trigeminal neuropathic pain. This technique involves the placement of a stimulating electrode adjacent to the trigeminal ganglion and can be trialed before permanent implantation. Wider adoption by surgical practitioners is currently limited by complications such as lead migration from the trigeminal ganglion, which can result in loss of therapy and cannot be rectified without repeat surgery. We describe a novel surgical modification that successfully anchors the trigeminal ganglion electrode long-term.
To describe a novel surgical technique for the anchoring of trigeminal ganglion stimulation electrodes and a case report of a patient with post-herpetic trigeminal neuropathic pain treated with this approach.
An electrode was inserted percutaneously through the foramen ovale into Meckel's cave, adjacent to the trigeminal ganglion. The lead was anchored using a modification of an existing anchoring device, which was inserted into the buccal incision. The lead was connected to a generator for therapeutic stimulation. The location of the lead was followed radiographically using serial lateral skull radiographs.
A 74-year-old male with post-herpetic trigeminal neuropathic pain, who had failed prior surgical therapies, underwent trigeminal ganglion stimulation. The trial lead was anchored using standard techniques and migrated outward within 7 days, rendering the trial electrode ineffective. The permanent lead was anchored using the described novel technique and remained in position without clinically significant outward migration nor loss in targeted stimulation until the last follow-up at 6 months.
Trigeminal ganglion stimulation is an effective therapeutic option for medically refractory trigeminal neuropathic pain. The novel surgical adaptation described prevents the outward migration of the lead and enables stable long-term lead placement.
三叉神经节刺激术是一种用于治疗三叉神经痛性疼痛的神经调节外科手术。该技术包括在三叉神经节附近放置刺激电极，并且可以在永久植入前进行试验。目前，该手术在外科医生中的更广泛应用受到诸如电极从三叉神经节移位等并发症的限制，这可能导致治疗失败，并且不进行再次手术就无法纠正。我们描述了一种新的手术改良方法，该方法成功地长期固定了三叉神经节电极。
描述一种用于固定三叉神经节刺激电极的新手术技术，并报告一例采用该方法治疗的疱疹后三叉神经痛性疼痛患者的病例。
通过卵圆孔经皮插入电极至Meckel腔，靠近三叉神经节。使用对现有固定装置的改良方法将导线固定，该装置插入颊部切口。将导线连接到发生器以进行治疗性刺激。通过连续的头颅侧位X线片对导线位置进行影像学跟踪。
一名74岁患有疱疹后三叉神经痛性疼痛且先前手术治疗失败的男性接受了三叉神经节刺激术。试验电极采用标准技术固定，但在7天内向外移位，导致试验电极无效。采用所述新技术固定永久电极，直至6个月的最后一次随访时，电极一直保持在原位，无临床上明显的向外移位，也无靶向刺激丧失。
三叉神经节刺激术是药物难治性三叉神经痛性疼痛的一种有效治疗选择。所描述的新手术改良方法可防止导线向外移位，并能实现导线的稳定长期放置。
