Presented at the 2013 AAPM Annual Meeting « Back

A Minimally Invasive Surgical Technique for the Treatment of Post-Traumatic Trigeminal Neuropathic Pain with Peripheral Nerve Stimulation

Jackson Cohen, MD, jcohen2@med.miami.edu¹, Sergio Lenchig, MD², (1) University of Miami Miller School of Medicine, Miami, Florida, (2) Fort Lauderdale Pain Medicine, Fort Lauderdale, Florida

Introduction/Statement of the Problem: Facial pain occurring after traumatic injury of the facial branches of the trigeminal nerve is a medical condition that is often very difficult to treat. Patients are quite disabled by their symptoms and most therapies are ineffective in relieving the pain. Peripheral nerve stimulation has been used as a treatment to provide pain relief for this type of intractable atypical facial pain. In this case, we describe a minimally invasive surgical technique for the treatment of post-traumatic trigeminal neuralgia with peripheral nerve stimulation. Materials and Methods: A patient with a clinical picture suggestive of trigeminal neuropathic pain secondary to trauma involving the V1 and V2 branches of the trigeminal nerve was selected. Conservative management was attempted with no improvement in pain before peripheral nerve stimulation was tried utilizing smaller incisions for placement of the leads and pulse generator as compared to a more invasive technique previously used by surgeons at our institution. Results: Following the procedure, there were no complications noted and the patient’s pain score decreased approximately 50%. At the three-month follow up visit, the patient reported continued pain relief and a better quality of life with improvement in her daily function; she also had no complaints regarding the device. Conclusions: This surgical technique for placing peripheral nerve stimulators allows for a minimally invasive approach for the treatment of intractable post-traumatic trigeminal neuralgia with potentially less risk of facial nerve damage. More studies are still needed to confirm the safety and effectiveness of this technique. References: 1) Weddington WW Jr, Blazer D. Atypical facial pain and trigeminal neuralgia: a comparison study. Psychosomatics. 1979 May;20(5):348-9, 362, 365-6. 2) Yakovlev AE, Resch BE. Treatment of chronic intractable atypical facial pain using peripheral subcutaneous field stimulation. Neuromodulation. 2010 Apr;13(2):137-40. 3) Johnson MD, Burchiel KJ. Peripheral stimulation for treatment of trigeminal postherpetic neuralgia and trigeminal posttraumatic neuropathic pain: a pilot study. Neurosurgery. 2004 Jul;55(1):135-41; discussion 141-2.

Funding: None

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