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Sarica C, Iorio-Morin C, Aguirre-Padilla DH, Paff M, Villeneuve SA, Vetkas A, Yamamoto K, Samuel N, Milano V, Loh A, Santyr B, Zemmar A, Lozano AM, Hodaie M. Clinical outcomes and complications of peripheral nerve field stimulation in the management of refractory trigeminal pain: a systematic review and meta-analysis. J Neurosurg 2022; 137:1387-1395. [PMID: 35180702 DOI: 10.3171/2021.12.jns212869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Peripheral nerve field stimulation (PNFS) is a tool in the armamentarium of treatment options for trigeminal pain. The efficacy of this modality in mitigating trigeminal pain remains unclear. The aim of this study was to examine the existing literature on PNFS and elucidate pain score outcomes associated with its use in patients with trigeminal pain. METHODS A systematic review and meta-analysis was performed in accordance with the PRISMA framework. The PubMed, Web of Science, and Scopus databases were queried on June 10, 2020. Studies reporting pain outcomes in more than 5 adult patients treated with PNFS for facial pain were included. The primary outcome of the study was the mean difference in the visual analog scale (VAS) score from the last follow-up to baseline, and it was analyzed by an inverse-variance, random-effect model. The risk of bias was assessed using the Newcastle-Ottawa Scale and a funnel plot. RESULTS Of the 4597 studies screened for inclusion, 46 relevant full-text articles were assessed for eligibility. Eleven observational cohort studies from the 46 articles were found to be eligible, and reported on a total of 109 patients. In 86% (94/109) of cases, trial stimulation was successful and followed by a permanent system implantation. VAS scores improved by 75% (mean difference 6.32/10 points, 95% CI 5.38-7.27 points) compared to baseline. Seventy-six percent (42/55) of patients became medication free or required lower doses of medications. The complication rate necessitating surgical revision was estimated at 32% per procedure. CONCLUSIONS These findings support the belief that PNFS provides effective, long-term pain control for trigeminal pain. Statistical heterogeneity was considerable across all studies. Future work should be aimed at conducting double-blind randomized controlled trials to determine the utility of PNFS for treating various forms of trigeminal pain for which limited therapeutic options exist.
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Affiliation(s)
- Can Sarica
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Christian Iorio-Morin
- 2Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Quebec, Canada
| | | | - Michelle Paff
- 4Department of Neurosurgery, University of California, Irvine, Orange, California
| | | | - Artur Vetkas
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
- 5Department of Neurosurgery, Tartu University Hospital, University of Tartu, Estonia
| | - Kazuaki Yamamoto
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Nardin Samuel
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Vanessa Milano
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Aaron Loh
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Brendan Santyr
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Ajmal Zemmar
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
- 6Department of Neurosurgery, Henan University School of Medicine, Zhengzhou, China
- 7Department of Neurosurgery, University of Louisville, Kentucky; and
| | - Andres M Lozano
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
- 8Krembil Research Institute, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
- 8Krembil Research Institute, Toronto, Ontario, Canada
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2
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Klein J, Siepmann T, Schackert G, Ziemssen T, Juratli TA. Peripheral nerve field stimulation in medically refractory trigeminal neuralgia attributed to multiple sclerosis. J Neurosurg 2021; 134:1244-1250. [DOI: 10.3171/2019.12.jns192261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/31/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Case reports and small patient series have suggested peripheral nerve field stimulation (PNFS) as a treatment for refractory trigeminal neuralgia attributed to multiple sclerosis (MS). Here, the authors aimed to assess the effects of this technique on long-term pain severity.
METHODS
Data were prospectively collected on patients with refractory trigeminal neuralgia attributed to MS who underwent PNFS between July 2013 and August 2017 at the authors’ neurosurgical department. Patients were evaluated before and after the first treatment as well as at follow-up at least twice a year. Patients underwent assessment of their pain severity using the Barrow Neurological Institute (BNI) Scale before treatment and at follow-up and were questioned about adverse events following cranial MRI performed after implantation of a permanent PNFS system.
RESULTS
Eight patients (3 women) underwent PNFS trials and their median age was 61 years (IQR 73.75 − 46.5 years). Seven patients proceeded to permanent implantation of the stimulation system. At a median follow-up of 33 months (IQR 42 − 24 months), pain severity decreased from baseline to the last follow-up (BNI score decrease from V [IQR V − V] to III [IQR V − III], p = 0.054). Four patients experienced long-lasting benefit (at 48, 33, 24, and 15 months’ follow-up, respectively), while in 3 patients the treatment eventually failed after an initially successful period. One patient had an infection, requiring system removal and subsequent reimplantation. No other complications occurred. No adverse events were noted in the patients undergoing MRI postimplantation.
CONCLUSIONS
This analysis indicates a possibly beneficial long-term effect of PNFS on refractory trigeminal neuralgia attributed to MS in some patients.
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Affiliation(s)
- Johann Klein
- 1Department of Neurosurgery, University Hospital Carl Gustav Carus
- 3Dresden International University, Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden, Germany
| | - Timo Siepmann
- 2Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden; and
- 3Dresden International University, Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden, Germany
| | | | - Tjalf Ziemssen
- 2Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden; and
| | - Tareq A. Juratli
- 1Department of Neurosurgery, University Hospital Carl Gustav Carus
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Texakalidis P, Tora MS, McMahon JT, Greven A, Anthony CL, Nagarajan P, Campbell M, Boulis NM. Percutaneous Trigeminal Stimulation for Intractable Facial Pain: A Case Series. Neurosurgery 2021; 87:547-554. [PMID: 32243534 DOI: 10.1093/neuros/nyaa065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/30/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Facial pain syndromes can be refractory to medical management and often need neurosurgical interventions. Neuromodulation techniques, including percutaneous trigeminal ganglion (TG) stimulation, are reversible and have emerged as alternative treatment options for intractable facial pain. OBJECTIVE To report the complication rates and analgesic effects associated with TG stimulation and identify potential predictors for these outcomes. METHODS A retrospective chart review of 59 patients with refractory facial pain who underwent TG stimulation was conducted. Outcomes following trial period and permanent stimulation were analyzed. Patients with >50% pain relief during trial stimulation received permanent implantation of the stimulation system. RESULTS Successful trial stimulation was endorsed by 71.2% of patients. During the trial period, 1 TG lead erosion was identified. History of trauma (facial/head trauma and oral surgery) was the only predictor of a failed trial compared to pain of idiopathic etiology (odds ratio: 0.15; 95% CI: 0.03-0.66). Following permanent implantation, approximately 29.6% and 26.5% of patients were diagnosed with lead erosion and infection of the hardware, respectively. TG lead migrations occurred in 11.7% of the patients. The numeric rating scale score showed a statistically significant reduction of 2.49 (95% CI: 1.37-3.61; P = .0001) at an average of 10.8 mo following permanent implantation. CONCLUSION TG stimulation is a feasible neuromodulatory approach for the treatment of intractable facial pain. Facial/head trauma and oral surgery may predict a nonsuccessful trial stimulation. Future development of specifically designed electrodes for stimulation of the TG, and solutions to reduce lead contamination are needed to mitigate the relatively high complication rate.
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Affiliation(s)
- Pavlos Texakalidis
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia
| | - Muhibullah S Tora
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia
| | - J Tanner McMahon
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia
| | - Alexander Greven
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia
| | - Casey L Anthony
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia
| | - Purva Nagarajan
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia
| | - Melissa Campbell
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia
| | - Nicholas M Boulis
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia
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Kohan L, Patel J, Abd-Elsayed A, Riley M. Neuromodulation for the Trigeminal Nerve. TRIGEMINAL NERVE PAIN 2021:155-168. [DOI: 10.1007/978-3-030-60687-9_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Al Barim B, Lemcke L, Schwake M, Schipmann S, Stummer W. Repetitive percutaneous radiofrequency thermocoagulation for persistent idiopathic facial pain and central neuropathic pain attributed to multiple sclerosis-a retrospective monocentric analysis. Acta Neurochir (Wien) 2020; 162:2791-2800. [PMID: 32662043 DOI: 10.1007/s00701-020-04486-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/06/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Persistent idiopathic facial pain (PIFP) is a debilitating chronic pain condition with pain radiating to trigeminal dermatomes. Typically, there are no pathological findings that can be identified during workup and therapy is symptomatic. Facial pain is common in patients with multiple sclerosis (central neuropathic pain attributed to MS). Our aim was to evaluate the effectiveness of percutaneous radiofrequency thermocoagulation (PRTC) of the gasserian ganglion and the duration of pain relief, as well as the identification of factors associated with its outcome. METHODS Data on all the above-mentioned patients that have been treated with PRTC between 2009 and 2019 were included into the study. The outcome was assessed with a six-tiered score from 1 (complete remission) to 6 (no benefit). Univariate and multivariate analyses were performed in order to obtain factors associated with the outcome. RESULTS A total of 52 patients were included. The total number of procedures performed was 114. 61.5% of patients who experienced temporary pain relief that lasted for a median of 60 days (range 3-1490 days). In patients with recurrence, the fraction of successful interventions was higher, and also transient, with successful pain amelioration in over 80% of patients. Successful responses to PRTC were observed in 27.9% after 1 year, 19.4% after 2 years, and 8.3% after 3 years. The only independent variable predicting pain relief was a repeat intervention with a history of ≥ 2 interventions (OR: 4.36, 95%-CI: 1.34-14.34, p = 0.015). No severe complications occurred. CONCLUSIONS Our data showed good and immediate pain relief after PRTC in the majority of our patients. PRTC is a low-risk procedure that can be discussed as an option in case of failure of medical treatment even in critically ill patients and can be repeated with good results when necessary. Long-term pain amelioration, even with repeated procedures, was not possible and no patient was permanently cured.
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Affiliation(s)
- Bilal Al Barim
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Lars Lemcke
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Stephanie Schipmann
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
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Han R, Guo G, Ni Y, Wang Z, Yang L, Zhang J, Li X, Hu R, Huang D, Zhou H. Clinical Efficacy of Short-Term Peripheral Nerve Stimulation in Management of Facial Pain Associated With Herpes Zoster Ophthalmicus. Front Neurosci 2020; 14:574713. [PMID: 33100962 PMCID: PMC7546869 DOI: 10.3389/fnins.2020.574713] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/19/2020] [Indexed: 11/13/2022] Open
Abstract
Objective Peripheral nerve stimulation may be an alternative option to treat severe facial pain. We assessed the application of peripheral nerve stimulation for pain management in patients with herpes zoster ophthalmicus. Method A retrospective analysis was conducted in patients suffering severe facial pain caused by ophthalmic herpetic lesions. We identified the change in pain severity before and after peripheral nerve stimulation for up to 12 months. Results Eighteen patients were enrolled. Their mean age was 70.8 ± 9.5 years. Fifteen patients presented with subacute pain for 1–3 months, and three patients suffered postherpetic neuralgia. Dramatic relief from pain was achieved in 83% of patients (15 out of 18) upon initial removal of the stimulator, with pain reduction of > 50%. The long-term analgesic effect was reported at the 6- and 12-month follow-ups, with reductions in the visual analog scale of 4.8 ± 1.2 (n = 18) and 5.4 ± 1.4 (n = 11), respectively. The prevalence of postherpetic neuralgia was 7% (1 out of 15) in the subacute pain group. No obvious adverse effect was observed. Conclusion Peripheral nerve stimulation may be an efficacious and safe approach for pain control in patients with herpes zoster ophthalmicus.
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Affiliation(s)
- Rui Han
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Gangwen Guo
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Yuncheng Ni
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Ziyang Wang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Liuqing Yang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Jianping Zhang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Xuelian Li
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Rong Hu
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Dong Huang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China.,Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
| | - Haocheng Zhou
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China.,Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
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7
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Texakalidis P, Tora MS, Anthony CL, Greven A, McMahon JT, Nagarajan P, Kasoff WS, AuYong N, Boulis NM. Peripheral trigeminal branch stimulation for refractory facial pain: A single-center experience. Clin Neurol Neurosurg 2020; 194:105819. [PMID: 32259672 DOI: 10.1016/j.clineuro.2020.105819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Facial pain refractory to medical treatments may benefit from neurosurgical interventions. Only a few studies have reported on the efficacy of peripheral trigeminal stimulation and more specifically supraorbital nerve (SON) and infraorbital nerve (ION) stimulation for the treatment of facial pain. PATIENTS AND METHODS In the present study, we identified all patients at our institution who underwent SON and/or ION stimulation for treatment of facial pain due to post-herpetic, traumatic or idiopathic etiology. Relevant pre and post-operative outcomes were analyzed. RESULTS We identified 15 patients who underwent SON and/or ION stimulation. Among them, 12 (80 %) endorsed >50 % pain relief during the trial stimulation period. After a median follow-up of 5.8 months with permanent implantation, 1 patient (8.3 %) was diagnosed with lead erosion and IPG migration, two patients had lead infections (16.7 %) and one (8.3 %) had wound dehiscence. No lead migrations were identified during the long-term follow-up. The VAS score showed a statistically significant reduction from a median pre-operative score of 7 to a post-operative score of 1.8 (p = 0.011), which corresponded to a 74.3 % average pain reduction. CONCLUSION SON and/or ION stimulation can be an effective treatment for intractable facial pain due to post-herpetic, traumatic or idiopathic etiology; however the complication rate is relatively high. Future prospective studies with longer follow-up periods are warranted.
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Affiliation(s)
- Pavlos Texakalidis
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, United States.
| | - Muhibullah S Tora
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, United States
| | - Casey L Anthony
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, United States
| | - Alexander Greven
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, United States
| | - J Tanner McMahon
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, United States
| | - Purva Nagarajan
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, United States
| | - Willard S Kasoff
- Department of Neurosurgery, School of Medicine, University of Arizona, Tucson, AZ, United States
| | - Nicholas AuYong
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, United States
| | - Nicholas M Boulis
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, GA, United States
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