Hospital Italiano de Buenos Aires.
Sanatorio Allende.
Rev Fac Cien Med Univ Nac Cordoba. 2023 Sep 29;80(3):275-288. doi: 10.31053/1853.0605.v80.n3.41142.
Trigeminal neuropathic pain (TNP) is a syndrome of severe, disabling, constant facial pain arising from the trigeminal nerve or ganglion. Arteriovenous malformations (AVM) are a rare cause of TNP. The limited choices of intervention of TNP include peripheral nerve stimulation, trigeminal nucleotomy and motor cortex stimulation.
We present a 56-year-old man who suffered from trigeminal neuropathic pain secondary to nerve compression due to a giant posterior fossa AVM. The pain was refractory to drug treatment. From all the therapeutic options available we declined the microvascular decompression of the trigeminal nerve due to the presence of the giant AVM, or stereotactic radiosurgery because of the AVM´s diffuse nidus. After a multidisciplinary discussion we proposed a minimally invasive, safe and reversible treatment: Motor Cortical Stimulation (MCS). We placed a 16-pole epidural electrode on the right precentral gyrus. The patient had satisfactory pain control with some supplemental medication. No complications or side effects such as seizures, sensory disturbances or infections were presented.
The limited choices of intervention of TNP include peripheral nerve stimulation, trigeminal nucleotomy and MCS. Henssen et al performed a systematic review where they investigated the effectiveness of MCS and discovered that this is significantly different among different chronic neuropathic orofacial pain disorders. A visual analogue scale (VAS) measured median pain relief of 66.5% was found.
MCS should be one more tool to consider in highly selected cases, when other treatments are unfeasible.
三叉神经病理性疼痛（TNP）是一种严重、致残、持续的面部疼痛综合征，源于三叉神经或神经节。动静脉畸形（AVM）是 TNP 的罕见病因。TNP 的干预选择有限，包括周围神经刺激、三叉神经节切开术和运动皮层刺激。
我们报告了一名 56 岁男性，因后颅窝巨大 AVM 压迫神经而导致三叉神经病理性疼痛。疼痛对药物治疗无反应。在所有可用的治疗选择中，由于存在巨大的 AVM，我们拒绝了三叉神经微血管减压术，或由于 AVM 的弥漫性病灶，我们拒绝了立体定向放射外科手术。经过多学科讨论，我们提出了一种微创、安全且可逆转的治疗方法：运动皮层刺激（MCS）。我们在右中央前回放置了一个 16 极硬膜外电极。患者疼痛得到了满意的控制，同时使用了一些辅助药物。没有出现癫痫、感觉障碍或感染等并发症或副作用。
TNP 的干预选择有限，包括周围神经刺激、三叉神经节切开术和 MCS。Henssen 等人进行了一项系统评价，研究了 MCS 的有效性，发现其在不同的慢性神经性或面部疼痛障碍中效果显著不同。使用视觉模拟量表（VAS）测量发现，中位疼痛缓解率为 66.5%。
当其他治疗方法不可行时，MCS 应该是另一种更具选择性的治疗方法。
