Interventional Pain Management, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
Pain Med. 2023 Mar 1;24(3):300-305. doi: 10.1093/pm/pnac120.
Trigeminal neuralgia is considered the worst pain a human being can experience. Initial treatment uses anticonvulsant sodium channel blockers, which relieve pain in approximately 70% of patients. In refractory cases, it is possible to perform ablative treatments, decompressive surgeries, and neuromodulatory techniques.
This report describes the treatment of a patient with refractory trigeminal neuralgia who continued to have a painful clinical presentation after four surgical procedures and three ablative procedures. The patient presented with severe pain (verbal numerical scale between 9 and 10), manifesting an evident suicidal ideation. A dorsal root ganglion (DRG) stimulation electrode was implanted in the trigeminal ganglion through intraoral puncture with maxillary fixation of the electrode, in order to minimize the chances of displacement. The test phase consisted of implanting a quadripolar electrode for DRG stimulation through puncture lateral to the buccal rim in a fluoroscopic coaxial view. The electrode was fixed to the skin and maintained for 5 days, during which the patient remained completely pain free. After the 5-day test period, the definitive stimulation electrode was implanted, this time with intraoral puncture and maxillary electrode fixation.
The patient remains pain free in the 3-month follow-up, with no displacement of the electrode.
The DRG electrode may be considered a therapeutic option in patients with severe trigeminal neuralgia. Controlled studies must be performed to determine the efficacy and safety of the method.
三叉神经痛被认为是人类所能经历的最剧烈的疼痛。初始治疗采用抗惊厥钠离子通道阻滞剂，大约 70%的患者可缓解疼痛。在难治性病例中，可以进行消融治疗、减压手术和神经调节技术。
本报告描述了一位难治性三叉神经痛患者的治疗情况，该患者在经历了四次手术和三次消融治疗后仍存在疼痛的临床症状。该患者疼痛剧烈（口述数字评分法 9-10 分），表现出明显的自杀意念。通过经口腔穿刺将背根神经节（DRG）刺激电极植入三叉神经节，并固定电极于上颌，以最大程度减少移位的可能性。测试阶段包括通过颊侧缘旁的透视同轴穿刺植入四极 DRG 刺激电极。将电极固定在皮肤上并保持 5 天，在此期间患者完全无痛。在 5 天的测试期后，植入永久性刺激电极，这次采用经口腔穿刺和上颌电极固定。
在 3 个月的随访中，患者疼痛持续缓解，电极未发生移位。
DRG 电极可能是治疗严重三叉神经痛的一种选择。必须进行对照研究以确定该方法的疗效和安全性。
