Taub E, Munz M, Tasker R R
Division of Neurosurgery, University of Toronto, Ontario, Canada.
J Neurosurg. 1997 Feb;86(2):197-202. doi: 10.3171/jns.1997.86.2.0197.
The use of an implanted system for chronic electrical stimulation of the gasserian ganglion for relief of facial pain was described in 1980 by Meyerson and Håkansson. Between 1982 and 1995, the senior author (R.R.T.) performed gasserian ganglion stimulation in 34 patients for the relief of chronic medically intractable facial pain. The etiology of pain was peripheral damage to the trigeminal nerve in 22 patients (65%), central (stroke) damage in seven (21%), postherpetic neuralgia in four (12%), and unclassifiable cause in one (3%). All patients received a trial of transcutaneous stimulation (Stage 1). Successful trials in 19 patients (56%) were followed by implantation of a permanent system (Stage II). Trial and postimplantation stimulation were deemed successful when there was a reduction of pain by at least 50% whenever the stimulator was on. Success rates varied from five (71%) of seven patients for central pain to five (23%) of 22 for peripheral pain and none (0%) of four for postherpetic neuralgia. The median follow-up duration in successful cases was 22.5 months. Infections occurred in seven patients, all of whom had undergone Stage II treatment. Infections were more frequent when the stimulating electrode from Stage I was left in place for Stage II (six [43%] of 14) than when completely new hardware was used and prophylactic antibiotic drugs were administered (one [20%] of five). Other complications included iatrogenic injury to the trigeminal nerve or ganglion in three cases (9%), transient diplopia in two (6%), increased pain in two (6%), and various technical problems in 10 (29%). It is concluded that pain of central origin (stroke) is the type most likely to be relieved by this procedure. This finding is new, as the few other clinical series reported to date contain no patients with this type of pain. The risk of infection seems to be lower when completely new hardware is used for Stage II and prophylactic antibiotic drugs are administered.
1980年，迈尔松和哈坎松描述了使用植入系统对三叉神经节进行慢性电刺激以缓解面部疼痛的方法。1982年至1995年期间，资深作者（R.R.T.）对34例患者进行了三叉神经节刺激，以缓解药物治疗无效的慢性面部疼痛。疼痛的病因在22例患者（65%）中是三叉神经的外周损伤，7例（21%）是中枢（中风）损伤，4例（12%）是带状疱疹后神经痛，1例（3%）病因不明。所有患者都接受了经皮刺激试验（第一阶段）。19例（56%）试验成功的患者随后植入了永久性系统（第二阶段）。当刺激器开启时疼痛减轻至少50%，则试验和植入后刺激被视为成功。成功率从7例中枢性疼痛患者中的5例（71%）到22例外周性疼痛患者中的5例（23%）不等，4例带状疱疹后神经痛患者无一例成功（0%）。成功病例的中位随访时间为22.5个月。7例患者发生感染，所有这些患者都接受了第二阶段治疗。与使用全新硬件并给予预防性抗生素药物相比，第一阶段的刺激电极在第二阶段仍保留在位时感染更频繁（14例中有6例[43%]）（5例中有1例[20%]）。其他并发症包括3例（9%）医源性三叉神经或神经节损伤、2例（6%）短暂性复视、2例（6%）疼痛加重以及10例（29%）各种技术问题。结论是，中枢性起源（中风）的疼痛是最有可能通过该手术缓解的类型。这一发现是新的，因为迄今为止报道的其他少数临床系列中没有此类疼痛的患者。当第二阶段使用全新硬件并给予预防性抗生素药物时，感染风险似乎较低。
