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Niu J, Wang C, Wang X, Lu G. Temporary Gasserian ganglion stimulation utilizing SNM electrode in subacute herpetic trigeminal neuralgia. Front Neurol 2024; 15:1435272. [PMID: 39087013 PMCID: PMC11289525 DOI: 10.3389/fneur.2024.1435272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/24/2024] [Indexed: 08/02/2024] Open
Abstract
Objective Gasserian ganglion stimulation (GGS) is a neuromodulation technique that has been extensively applied in treating postherpetic trigeminal neuralgia. However, permanent implantation of GGS was preferred in most treatment approaches. Few studies have investigated temporary GGS for the treatment of acute/subacute herpetic trigeminal neuralgia. Moreover, previous research has reported lead dislocation when utilizing traditional electrodes, which was associated with poor pain relief. In GGS research, preventing the accidental displacement of lead following implantation has consistently been a primary objective. Methods We report a case of a 70-year-old woman with subacute herpetic trigeminal neuralgia who underwent temporary GGS for 14 days utilizing a sacral neuromodulation (SNM) quadripolar-tined lead. Computed tomography-guided percutaneous foramen ovale (FO) puncture and temporary SNM electrode implantation were performed during the surgery. A telephone interview was conducted to record a 12-month follow-up. Results At admission, zoster-related trigeminal pain severity was assessed to be 9/10 on the visual analog scale (VAS). After a 14-day GGS treatment, the pain assessed on the VAS score reduced to 1/10 at discharge but increased to 4/10 at the 12-month follow-up after surgery. Additionally, the anxiety level improved from 58 points to 35 points on the Self-Rating Anxiety Scale (SAS), and the depression level improved from 62 points to 40 points on the Self-Rating Depression Scale (SDS). The Physical Component Summary score of the 12-item Short-Form Health Survey (SF-12) increased from 33.9 to 47.0, and the Mental Component Summary (MCS) score of the SF-12 increased from 27.4 to 41.9. Conclusion Temporary GGS might be a potentially effective treatment for subacute herpetic trigeminal neuralgia, and an SNM electrode might be a good choice for reducing the risk of dislocation.
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Affiliation(s)
- Jiejie Niu
- Department of Pain Management, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Chenhui Wang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xing Wang
- Department of Radiotherapy, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Guijun Lu
- Department of Pain Management, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Escobar-Vidarte ÓA, Alzate-Carvajal V, Mier-García JF. Gasserian ganglion stimulation for refractory trigeminal neuropathic pain. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024:S2341-1929(24)00076-3. [PMID: 38642897 DOI: 10.1016/j.redare.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/04/2024] [Accepted: 01/28/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND AND OBJECTIVE Painful trigeminal neuropathy is a complex clinical entity due to its severity and refractoriness to pharmacological and interventional management. We describe our experience in treating refractory painful trigeminal neuropathy (RPTN) with gasserian ganglion stimulation (GGS). MATERIALS AND METHODS Six patients with RPTN were treated with GGS in our Unit between 2019 and 2022. The following data were collected: socio-demographic characteristics, triggering event, duration of the disease and treatment received prior to surgery, pre- and post-intervention visual analogue scale (VAS) score, follow-up time, and pre- and post-intervention functionality and quality of life. RESULTS All patients were women who had received aggressive first-, second-, and third-line pharmacological, non-pharmacological, and interventional management before being referred for GGS. Patients reported a 50%-72% decrease in pain on VAS and improved functionality during follow-up. CONCLUSIONS GGS is a promising therapeutic alternative for patients with RPTN. Although the initial outcomes and experience are encouraging, RPTN is recommended on the basis of safety, reproducibility, and trends observed in clinical practice.
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Affiliation(s)
- Ó A Escobar-Vidarte
- Sección de Neurocirugía, Facultad de Salud, Universidad del Valle, Cali, Colombia; Hospital Universitario del Valle, Cali, Colombia; Hospital Universitario Fundación Clínica Valle del Lili, Cali, Colombia
| | - V Alzate-Carvajal
- Hospital Universitario Fundación Clínica Valle del Lili, Cali, Colombia; Universidad Icesi, Hospital Universitario Fundación Valle del Lili, Cali, Colombia
| | - J F Mier-García
- Sección de Neurocirugía, Facultad de Salud, Universidad del Valle, Cali, Colombia; Clínica de Alta Complejidad Santa Bárbara, Palmira, Colombia; Clínica Rey David, Cali, Colombia.
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Pak RJ, Ku JB, Abd-Elsayed A. Neuromodulation for Craniofacial Pain and Headaches. Biomedicines 2023; 11:3328. [PMID: 38137549 PMCID: PMC10741888 DOI: 10.3390/biomedicines11123328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Headaches and facial pain are highly prevalent diseases but are often difficult to treat. Though there have been significant advances in medical management, many continue to suffer from refractory pain. Neuromodulation has been gaining interest for its therapeutic purposes in many chronic pain conditions, including headaches and facial pain. There are many potential targets of neuromodulation for headache and facial pain, and some have more robust evidence in favor of their use than others. Despite the need for more high-quality research, the available evidence for the use of neuromodulation in treating headaches and facial pain is promising. Considering the suffering that afflicts patients with intractable headache, neuromodulation may be an appropriate tool to improve not only pain but also disability and quality of life.
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Affiliation(s)
- Ray J. Pak
- Department of Physical Medicine and Rehabilitation, New York Medical College, Metropolitan Hospital, New York, NY 10029, USA;
| | - Jun B. Ku
- Department of Physical Medicine and Rehabilitation, New York Medical College, Metropolitan Hospital, New York, NY 10029, USA;
| | - Alaa Abd-Elsayed
- Department of Anesthesia, University of Wisconsin, Madison, WI 53792, USA
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Wang C, Dou Z, Yan M, Wang B. Efficacy and Safety of Pulsed Radiofrequency in Herpes Zoster Related Trigeminal Neuralgia: A Systematic Review and Meta-Analysis. J Pain Res 2023; 16:341-355. [PMID: 36756203 PMCID: PMC9901482 DOI: 10.2147/jpr.s396209] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
Purpose Pulsed radiofrequency (PRF) is a neuromodulation technique for neuropathic pain. However, the effects of PRF on zoster-related trigeminal neuralgia (TN) remain unclear. The purpose of this meta-analysis is to investigate the efficacy and safety of PRF in the management of zoster-related TN. Patients and Methods We searched PubMed, Embase, Cochrane Library, Chinese Biomedical Database (CBM), Chinese National Knowledge Infrastructure (CNKI), and Wanfang for randomized controlled trials from their inception to August 2022. The primary clinical outcomes included pain intensity and adverse events. Secondary clinical outcomes included pain remission rate, trigeminal postherpetic neuralgia (TPHN) incidence, rescue analgesic dose, sleep quality, and quality of life (QoL). Results Eight studies with 788 participants were included for final analysis. PRF group exhibited lower pain scores (week 1: MD -2.10, 95% CI -3.28 to -0.93, P=0.0005; week 4: MD -1.56, 95% CI -2.60 to -0.51, P=0.003; week 12: MD -1.52, 95% CI -2.68 to -0.35, P=0.01), lower risk of TPHN incidence (RR 0.22, 95% CI 0.06 to 0.81, P=0.02) and better sleep quality (week 4: MD -2.52, 95% CI -3.28 to -1.77, P<0.01; week 12: MD -2.25, 95% CI -2.90 to -1.60, P<0.01) than control group. Besides, pain remission rate (RR 1.08, 95% CI 0.93 to 1.26, P=0.31) and adverse events (RR 0.95, 95% CI 0.71 to 1.27, P=0.74) were comparable in both groups. Conclusion PRF is an effective and safe treatment and it yields better effects in pain relief, improvement of sleep quality, and prevention of developing TPHN. Although PRF provides a comparable pain remission rate with the control, it is still a preferred and alternative treatment for relieving zoster-related facial pain.
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Affiliation(s)
- Chenhui Wang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zhi Dou
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Mengwei Yan
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Baoguo Wang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, People’s Republic of China,Correspondence: Baoguo Wang, Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, No. 50 Yikesong Street, Haidian District, Beijing, 100095, People’s Republic of China, Tel/Fax +86 10 6285 6766, Email
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KC E, Islam J, Park YS. Trigeminal ganglion itself can be a viable target to manage trigeminal neuralgia. J Headache Pain 2022; 23:150. [PMID: 36424545 PMCID: PMC9686102 DOI: 10.1186/s10194-022-01512-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/26/2022] [Indexed: 11/25/2022] Open
Abstract
Excruciating trigeminal neuralgia (TN) management is very difficult and severely affects the patient's quality of life. Earlier studies have shown that the trigeminal ganglion (TG) comprises several receptors and signal molecules that are involved in the process of peripheral sensitization, which influences the development and persistence of neuropathic pain. Targeting TG can modulate this sensitization pathway and mediate the pain-relieving effect. So far,there are few studies in which modulation approaches to TG itself have been suggested so far. "Trigeminal ganglion modulation" and "trigeminal neuralgia" were used as search phrases in the Scopus Index and PubMed databases to discover articles that were pertinent to the topic. In this review, we address the role of the trigeminal ganglion in TN and underlying molecules and neuropeptides implicated in trigeminal pain pathways in processing pathological orofacial pain. We also reviewed different modulation approaches in TG for TN management. Furthermore, we discuss the prospect of targeting trigeminal ganglion to manage such intractable pain.
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Affiliation(s)
- Elina KC
- grid.254229.a0000 0000 9611 0917Program in Neuroscience, Department of Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Jaisan Islam
- grid.254229.a0000 0000 9611 0917Program in Neuroscience, Department of Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Young Seok Park
- grid.254229.a0000 0000 9611 0917Program in Neuroscience, Department of Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea ,grid.411725.40000 0004 1794 4809Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Korea
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Logghe Y, Smet I, Jerjir A, Verelst P, Devos M, Van Buyten JP. Trigeminal neuropathy: Two case reports of gasserian ganglion stimulation. Brain Behav 2021; 11:e2379. [PMID: 34661988 PMCID: PMC8613404 DOI: 10.1002/brb3.2379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/12/2021] [Accepted: 09/14/2021] [Indexed: 11/19/2022] Open
Abstract
This report describes the successful treatment of two patients with trigeminal neuropathy by using gasserian ganglion stimulation. Case reports: The first case report deals with a 53-year-old woman suffering from right-sided facial pain after a gamma knife lesion for schwannoma of the right inner ear. For 9 years, several interventions with the aim of relieving the pain were unsuccessful; in fact, they had aggravated the symptoms. A trial with a neurostimulator at the level of the Gasser ganglion had an immediately positive effect on her score for facial pain, which decreased from 7.3 to 0 on a visual analog scale, assessed during a period of 2 months. Additionally, the patient had weaned off all her medication by the end of the period. The second case report describes a 64-year-old man suffering from trigeminal neuropathy, which mainly manifested itself as an itch. For a period of 15 years, neither medication nor several interventions were effective. A trial with an electrode at the level of the Gasser ganglion reduced his pain score from 7.0 to 1.5 on a visual analog scale, assessed during a period of three months. His medication could be limited to pregabalin 150 mg bidaily. In contrast, prior to the implantation, his oral medication consisted of pregabalin 75 mg up to five times a day. Conclusion: These case reports show that stimulation of the gasserian ganglion is a successful, minimally invasive, and non-destructive treatment in refractory trigeminal neuropathy and should be considered earlier in the treatment algorithm of trigeminal neuropathy.
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Affiliation(s)
- Yannick Logghe
- Multidisciplinary Pain Center, AZ Nikolaas, Sint-Niklaas, Belgium.,Department of Anesthesiology, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Iris Smet
- Multidisciplinary Pain Center, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Ali Jerjir
- Multidisciplinary Pain Center, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Peter Verelst
- Department of Anesthesiology, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Marieke Devos
- Multidisciplinary Pain Center, AZ Nikolaas, Sint-Niklaas, Belgium
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