Abstract ID: A6
Abstract Title: Supraorbital Nerve Stimulation for the Treatment of Intractable Postherpetic Trigeminal Neuralgia
Authors: Narouze S
The Cleveland Clinic Foundation Cleveland OH USA
Poster Type: Poster
ABSTRACT BODY
Introduction:
The treatment of postherpetic trigeminal neuralgia is often refractory to medical management. Gasserian ganglion electrical stimulation has been reported before for the treatment of trigeminal neuralgia, however it was unsuccessful in postherpetic trigeminal neuralgia.1 Also this approach is unreliable and carries a high potential for serious complications.
Here we report a case of intractable postherpetic trigeminal neuralgia in the distribution of the supraorbital nerve with excellent pain control with supraorbital nerve stimulation.
Case Report:
82-year-old female with a h/o herpes zoster infection in the distribution of the right supraorbital nerve about 3 years ago. She continued to complain of severe postherpetic neuralgia that was refractory to anti-inflammatory, anticonvulsant, antidepressant, and narcotic medications. She has severe allodynia over the right supraorbital and right frontal areas, and she has extreme difficulty with washing her face and brushing her hair. She had good pain relief, however temporary, after supraorbital nerve block with local anesthetic. She continued to rate her pain as constant 10/10 on the visual analogue scale despite the above pharmacological management. After appropriate psychological evaluation she was felt to be a good candidate for a trial of supraorbital nerve stimulation. She underwent a successful 7 days trial with a percutaneous quadripolar electrode (Quattrode, ANS Inc., Plano, TX), that was placed horizontally crossing the course of the nerve just above the supraorbital ridge. She reported >75% pain relief from the trial, subsequently she underwent a permanent implant of a surgical “paddle” lead (Lamitrode-4, ANS Inc.,), that was tunneled and anchored behind the ear and then connected to the generator placed in the infraclavicular area.
Nine months after the implant, the patient still denies any significant pain (pain score 1/10) and reports good coverage with marked improvement of the allodynia. Since the implant she didn’t require any narcotics or other pain medications.
Discussion:
Peripheral nerve stimulation has been used for years in the treatment of intractable neuropathic pain from peripheral nerve injury.
Recently there is interest in applying this modality of treatment in treating occipital neuralgia and other craniofacial pains.2,3 Previous reports showed that gasserian ganglion stimulation was not that reliable in controlling pain from trigeminal neuralgia, especially postherpetic trigeminal neuralgia(<10%).1
Here we report a relatively simple, safe, and effective treatment of intractable postherpetic trigeminal neuralgia with supraorbital nerve stimulation. We used the surgical flat “paddle” lead for the permanent implant to provide better current distribution and less current surges that occurred with the smaller percutaneous “barrel” lead that was used during the trial.
References:
1- Arch Physiol biochem 2001; 304:304-308
2- Neuromodulation 2005; 8:7-13.
A6- Anesth Analg 2005; 101:171-4.
ATTACHED FILES
Reg Anesth Pain Med 2005; 30(3):A6