Sokal Paweł, Kierońska-Siwak Sara, Rusinek Marcin, Jabłońska Magdalena, Nehring Antoni, Puk Oskar, Palus Damian, Jabłońska Renata
Department of Neurosurgery, Functional and Stereotactic Neurosurgery, Faculty of Health Sciences Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland.
Doctoral School Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
Front Neurol. 2025 May 14;16:1535102. doi: 10.3389/fneur.2025.1535102. eCollection 2025.
Unlike idiopathic trigeminal neuralgia, which can be treated with conventional neurosurgical methods such as microvascular decompression, radiofrequency rhizotomy of the Gasser ganglion, or stereotactic radiosurgery, trigeminal neuropathic pain (TNP) presents a major challenge for neurosurgeons. Injury to the trigeminal system resulting in chronic refractory pain can be treated with neuromodulation methods, such as peripheral nerve stimulation, motor cortex stimulation, or deep brain stimulation. Sphenopalatine ganglion (SPG) stimulation has been successfully applied in patients with cluster headaches and migraine. This study aimed to evaluate the response of patients with TNP to permanent percutaneous SPG stimulation.
We studied six patients treated with SPG stimulation for TNP. All patients had previously been treated with RF rhizotomy, microvascular decompression, or stereoradiosurgery without a satisfactory long-term therapeutic effect and had recurrent, mostly constant TNP. An electrode lead was implanted in the pterygopalatine fossa of all patients to stimulate the SPG under guidance of neuronavigation with an implantable pulse generator inserted after a two-week trial period.
Preoperatively, the mean visual analog scale score was 9. Two weeks after the trial stimulation, it decreased to 3.6 in six patients. In four patients, the score further decreased to 3.0 after 6 months and 2.25 after 12 months, accompanied by an improvement in health status, as measured by the 36-Item Short Form Health Survey questionnaire. In two patients, the electrodes were externalized through eroded skin after 3 months, and stimulators were removed.
The preliminary results of this pilot study are encouraging. Pain relief after the trial stimulation was found to be notable. The treatment procedure was safe, and the stimulation effect was durable. SPG stimulation is an attractive alternative to other neuromodulation methods.
与可采用微血管减压、半月神经节射频切断术或立体定向放射外科等传统神经外科方法治疗的特发性三叉神经痛不同，三叉神经病理性疼痛（TNP）给神经外科医生带来了重大挑战。导致慢性难治性疼痛的三叉神经系统损伤可采用神经调节方法治疗，如外周神经刺激、运动皮层刺激或深部脑刺激。蝶腭神经节（SPG）刺激已成功应用于丛集性头痛和偏头痛患者。本研究旨在评估TNP患者对永久性经皮SPG刺激的反应。
我们研究了6例接受SPG刺激治疗TNP的患者。所有患者此前均接受过射频切断术、微血管减压术或立体定向放射外科治疗，但未获得满意的长期治疗效果，且TNP复发，大多为持续性疼痛。在所有患者的翼腭窝植入电极导线，在神经导航引导下刺激SPG，经过两周的试验期后植入植入式脉冲发生器。
术前，视觉模拟量表平均评分为9分。试验刺激两周后，6例患者的评分降至3.6分。4例患者在6个月后评分进一步降至3.0分，12个月后降至2.25分，同时健康状况有所改善，这通过36项简明健康调查问卷进行评估。2例患者在3个月后电极因皮肤侵蚀而外置，刺激器被移除。
这项初步研究的结果令人鼓舞。试验刺激后的疼痛缓解显著。治疗过程安全，刺激效果持久。SPG刺激是其他神经调节方法的一种有吸引力的替代方法。
