Acta Neurochirurgica

, Volume 158, Issue 3, pp 513–520 | Cite as

Trigeminal and sphenopalatine ganglion stimulation for intractable craniofacial pain—case series and literature review

  • Arsani William
  • Tej Deepak Azad
  • Eliezer Brecher
  • Taissa Cherry
  • Ivan Bernstein
  • Diana M. Bruce
  • Stacey Rohrer
  • Zachary Smith
  • Mary William
  • Eric Sabelman
  • Gary Heit
  • Patrick Pezeshkian
  • Mark SedrakEmail author
Clinical Article - Functional



Facial pain is often debilitating and can be characterized by a sharp, stabbing, burning, aching, and dysesthetic sensation. Specifically, trigeminal neuropathic pain (TNP), anesthesia dolorosa, and persistent idiopathic facial pain (PIFP) are difficult diseases to treat, can be quite debilitating and an effective, enduring treatment remains elusive.


We retrospectively reviewed our early experience with stimulation involving the trigeminal and sphenopalatine ganglion stimulation for TNP, anesthesia dolorosa, and PIFP between 2010–2014 to assess the feasibility of implanting at these ganglionic sites. Seven patients received either trigeminal and/or sphenopalatine ganglion stimulation with or without peripheral nerve stimulation, having failed multiple alternative modalities of treatment. The treatments were tailored on the physical location of pain to ensure regional coverage with the stimulation.


Fluoroscopy or frameless stereotaxy was utilized to place the sphenopalatine and/or trigeminal ganglion stimulator. All patients were initially trialed before implantation. Trial leads implanted in the pterygopalatine fossa near the sphenopalatine ganglion were implanted via transpterygoid (lateral-medial, infrazygomatic) approach. Trial leads were implanted in the trigeminal ganglion via percutaneous Hartel approach, all of which resulted in masseter contraction. Patients who developed clinically significant pain improvement underwent implantation. The trigeminal ganglion stimulation permanent implants involved placing a grid electrode over Meckel’s cave via subtemporal craniotomy, which offered a greater ability to stimulate subdivisions of the trigeminal nerve, without muscular (V3) side effects. Two of the seven overall patients did not respond well to the trial and were not implanted. Five patients reported pain relief with up to 24-month follow-up. Several of the sphenopalatine ganglion stimulation patients had pain relief without any paresthesias. There were no electrode migrations or post-surgical complications.


Refractory facial pain may respond positively to ganglionic forms of stimulation. It appears safe and durable to implant electrodes in the pterygopalatine fossa via a lateral transpterygoid approach. Also, implantation of an electrode grid overlying Meckel’s cave appears to be a feasible alternative to the Hartel approach. Further investigation is needed to evaluate the usefulness of these approaches for various facial pain conditions.


Trigeminal neuralgia Anesthesia dolorosa Persistent idiopathic facial pain Sphenopalatine ganglion 


Compliance with ethical standards


No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Patient consent statement

For this type of study formal consent is not required. However, the patients have consented to submission of this case series to the journal.


  1. 1.
    Jensen TS, Baron R, Haanpaa M, Kalso E, Loeser JD, Rice AS, Treede RD (2011) A new definition of neuropathic pain. Pain 152:2204–2205CrossRefPubMedGoogle Scholar
  2. 2.
    Torrance N, Smith BH, Bennett MI, Lee AJ (2006) The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. J Pain 7:281–289CrossRefPubMedGoogle Scholar
  3. 3.
    Burchiel KJ (2003) A new classification for facial pain. Neurosurgery 53:1164–1166, discussion 1166–1167CrossRefPubMedGoogle Scholar
  4. 4.
    Sharma M, Shaw A, Deogaonkar M (2014) Surgical options for complex craniofacial pain. Neurosurg Clin N Am 25:763–775CrossRefPubMedGoogle Scholar
  5. 5.
    Dworkin RH (2002) An overview of neuropathic pain: syndromes, symptoms, signs, and several mechanisms. Clin J Pain 18:343–349CrossRefPubMedGoogle Scholar
  6. 6.
    Headache Classification Subcommittee of the International Headache S (2004) The International Classification of Headache Disorders: 2nd edition. Cephalalgia 24(Suppl 1):9–160Google Scholar
  7. 7.
    Obermann M, Holle D, Katsarava Z (2011) Trigeminal neuralgia and persistent idiopathic facial pain. Expert Rev Neurother 11:1619–1629CrossRefPubMedGoogle Scholar
  8. 8.
    Rozen TD (1999) Relief of anesthesia dolorosa with gabapentin. Headache 39:761–762CrossRefPubMedGoogle Scholar
  9. 9.
    Zakrzewska JM (2010) Medical management of trigeminal neuropathic pains. Expert Opin Pharmacother 11:1239–1254CrossRefPubMedGoogle Scholar
  10. 10.
    Cruccu G, Aziz TZ, Garcia-Larrea L, Hansson P, Jensen TS, Lefaucheur JP, Simpson BA, Taylor RS (2007) EFNS guidelines on neurostimulation therapy for neuropathic pain. Eur J Neurol 14:952–970CrossRefPubMedGoogle Scholar
  11. 11.
    Flor H, Elbert T, Knecht S, Wienbruch C, Pantev C, Birbaumer N, Larbig W, Taub E (1995) Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature 375:482–484CrossRefPubMedGoogle Scholar
  12. 12.
    Petersen EA, Slavin KV (2014) Peripheral nerve/field stimulation for chronic pain. Neurosurg Clin N Am 25:789–797CrossRefPubMedGoogle Scholar
  13. 13.
    Sindrup SH, Jensen TS (2002) Pharmacotherapy of trigeminal neuralgia. Clin J Pain 18:22–27CrossRefPubMedGoogle Scholar
  14. 14.
    Dhople AA, Adams JR, Maggio WW, Naqvi SA, Regine WF, Kwok Y (2009) Long-term outcomes of Gamma Knife radiosurgery for classic trigeminal neuralgia: implications of treatment and critical review of the literature. Clinical article. J Neurosurg 111:351–358CrossRefPubMedGoogle Scholar
  15. 15.
    Natarajan M (2000) Percutaneous trigeminal ganglion balloon compression: experience in 40 patients. Neurol India 48:330–332PubMedGoogle Scholar
  16. 16.
    Steude U (1984) Radiofrequency electrical stimulation of the Gasserian ganglion in patients with atypical trigeminal pain: methods of percutaneous temporary test-stimulation and permanent implantation of stimulation devices. Acta Neurochir Suppl 33:481–486Google Scholar
  17. 17.
    Broggi G, Servello D, Franzini A, Giorgi C (1987) Electrical stimulation of the Gasserian ganglion for facial pain: preliminary results. Acta Neurochir Suppl 39:144–146CrossRefPubMedGoogle Scholar
  18. 18.
    Young RF (1995) Electrical stimulation of the trigeminal nerve root for the treatment of chronic facial pain. J Neurosurg 83:72–78CrossRefPubMedGoogle Scholar
  19. 19.
    Elahi F, Reddy CG (2015) Sphenopalatine ganglion electrical nerve stimulation implant for intractable facial pain. Pain Physician 18:E403–409PubMedGoogle Scholar
  20. 20.
    Brown JA, Pilitsis JG (2005) Motor cortex stimulation for central and neuropathic facial pain: a prospective study of 10 patients and observations of enhanced sensory and motor function during stimulation. Neurosurgery 56:290–297, discussion 290–297CrossRefPubMedGoogle Scholar
  21. 21.
    Fontaine D, Hamani C, Lozano A (2009) Efficacy and safety of motor cortex stimulation for chronic neuropathic pain: critical review of the literature. J Neurosurg 110:251–256CrossRefPubMedGoogle Scholar
  22. 22.
    Raslan AM, Nasseri M, Bahgat D, Abdu E, Burchiel KJ (2011) Motor cortex stimulation for trigeminal neuropathic or deafferentation pain: an institutional case series experience. Stereotact Funct Neurosurg 89:83–88CrossRefPubMedGoogle Scholar
  23. 23.
    Gybels J, Kupers R, Nuttin B (1993) Therapeutic stereotactic procedures on the thalamus for pain. Acta Neurochir (Wien) 124:19–22CrossRefGoogle Scholar
  24. 24.
    Young RF, Chambi VI (1987) Pain relief by electrical stimulation of the periaqueductal and periventricular gray matter. Evidence for a non-opioid mechanism. J Neurosurg 66:364–371CrossRefPubMedGoogle Scholar
  25. 25.
    Rasche D, Rinaldi PC, Young RF, Tronnier VM (2006) Deep brain stimulation for the treatment of various chronic pain syndromes. Neurosurg Focus 21, E8CrossRefPubMedGoogle Scholar
  26. 26.
    Gorecki JP, Nashold BS (1995) The Duke experience with the nucleus caudalis DREZ operation. Acta Neurochir Suppl 64:128–131CrossRefPubMedGoogle Scholar
  27. 27.
    Bullard DE, Nashold BS Jr (1997) The caudalis DREZ for facial pain. Stereotact Funct Neurosurg 68:168–174CrossRefPubMedGoogle Scholar
  28. 28.
    Kanpolat Y, Kahilogullari G, Ugur HC, Elhan AH (2008) Computed tomography-guided percutaneous trigeminal tractotomy-nucleotomy. Neurosurgery 63:ONS147–153, discussion ONS153-145PubMedGoogle Scholar
  29. 29.
    Sandwell SE, El-Naggar AO (2013) Nucleus caudalis dorsal root entry zone lesioning for the treatment of anesthesia dolorosa. J Neurosurg 118:534–538CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • Arsani William
    • 1
  • Tej Deepak Azad
    • 2
  • Eliezer Brecher
    • 1
  • Taissa Cherry
    • 3
  • Ivan Bernstein
    • 3
  • Diana M. Bruce
    • 3
  • Stacey Rohrer
    • 3
  • Zachary Smith
    • 4
  • Mary William
    • 3
  • Eric Sabelman
    • 3
  • Gary Heit
    • 3
  • Patrick Pezeshkian
    • 3
  • Mark Sedrak
    • 3
    Email author
  1. 1.Medical SchoolHarvard UniversityCambridgeUSA
  2. 2.Stanford University School of MedicineStanfordUSA
  3. 3.Department of NeurosurgeryKaiser Permanente-The Permanente Medical Group (TPMG)Redwood CityUSA
  4. 4.Department of NeurosurgeryNorthwestern UniversityEvanstonUSA

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