Skip to main content
SpringerLink
Log in

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

  • Clinical Article - Functional
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Jensen TS, Baron R, Haanpaa M, Kalso E, Loeser JD, Rice AS, Treede RD (2011) A new definition of neuropathic pain. Pain 152:2204–2205

    Article  PubMed  Google Scholar 

  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 7:281–289

    Article  PubMed  Google Scholar 

  3. Burchiel KJ (2003) A new classification for facial pain. Neurosurgery 53:1164–1166, discussion 1166–1167

    Article  PubMed  Google Scholar 

  4. Sharma M, Shaw A, Deogaonkar M (2014) Surgical options for complex craniofacial pain. Neurosurg Clin N Am 25:763–775

    Article  PubMed  Google Scholar 

  5. Dworkin RH (2002) An overview of neuropathic pain: syndromes, symptoms, signs, and several mechanisms. Clin J Pain 18:343–349

    Article  PubMed  Google Scholar 

  6. Headache Classification Subcommittee of the International Headache S (2004) The International Classification of Headache Disorders: 2nd edition. Cephalalgia 24(Suppl 1):9–160

    Google Scholar 

  7. Obermann M, Holle D, Katsarava Z (2011) Trigeminal neuralgia and persistent idiopathic facial pain. Expert Rev Neurother 11:1619–1629

    Article  PubMed  Google Scholar 

  8. Rozen TD (1999) Relief of anesthesia dolorosa with gabapentin. Headache 39:761–762

    Article  CAS  PubMed  Google Scholar 

  9. Zakrzewska JM (2010) Medical management of trigeminal neuropathic pains. Expert Opin Pharmacother 11:1239–1254

    Article  CAS  PubMed  Google Scholar 

  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 14:952–970

    Article  CAS  PubMed  Google Scholar 

  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 375:482–484

    Article  CAS  PubMed  Google Scholar 

  12. Petersen EA, Slavin KV (2014) Peripheral nerve/field stimulation for chronic pain. Neurosurg Clin N Am 25:789–797

    Article  PubMed  Google Scholar 

  13. Sindrup SH, Jensen TS (2002) Pharmacotherapy of trigeminal neuralgia. Clin J Pain 18:22–27

    Article  PubMed  Google Scholar 

  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 111:351–358

    Article  PubMed  Google Scholar 

  15. Natarajan M (2000) Percutaneous trigeminal ganglion balloon compression: experience in 40 patients. Neurol India 48:330–332

    CAS  PubMed  Google Scholar 

  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 33:481–486

    Google Scholar 

  17. Broggi G, Servello D, Franzini A, Giorgi C (1987) Electrical stimulation of the Gasserian ganglion for facial pain: preliminary results. Acta Neurochir Suppl 39:144–146

    Article  CAS  PubMed  Google Scholar 

  18. Young RF (1995) Electrical stimulation of the trigeminal nerve root for the treatment of chronic facial pain. J Neurosurg 83:72–78

    Article  CAS  PubMed  Google Scholar 

  19. Elahi F, Reddy CG (2015) Sphenopalatine ganglion electrical nerve stimulation implant for intractable facial pain. Pain Physician 18:E403–409

    PubMed  Google Scholar 

  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 290–297

    Article  PubMed  Google Scholar 

  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 110:251–256

    Article  PubMed  Google Scholar 

  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 89:83–88

    Article  PubMed  Google Scholar 

  23. Gybels J, Kupers R, Nuttin B (1993) Therapeutic stereotactic procedures on the thalamus for pain. Acta Neurochir (Wien) 124:19–22

    Article  CAS  Google Scholar 

  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 66:364–371

    Article  CAS  PubMed  Google Scholar 

  25. Rasche D, Rinaldi PC, Young RF, Tronnier VM (2006) Deep brain stimulation for the treatment of various chronic pain syndromes. Neurosurg Focus 21, E8

    Article  PubMed  Google Scholar 

  26. Gorecki JP, Nashold BS (1995) The Duke experience with the nucleus caudalis DREZ operation. Acta Neurochir Suppl 64:128–131

    Article  CAS  PubMed  Google Scholar 

  27. Bullard DE, Nashold BS Jr (1997) The caudalis DREZ for facial pain. Stereotact Funct Neurosurg 68:168–174

    Article  CAS  PubMed  Google Scholar 

  28. Kanpolat Y, Kahilogullari G, Ugur HC, Elhan AH (2008) Computed tomography-guided percutaneous trigeminal tractotomy-nucleotomy. Neurosurgery 63:ONS147–153, discussion ONS153-145

    PubMed  Google Scholar 

  29. Sandwell SE, El-Naggar AO (2013) Nucleus caudalis dorsal root entry zone lesioning for the treatment of anesthesia dolorosa. J Neurosurg 118:534–538

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical School, Harvard University, Cambridge, MA, USA

    Arsani William & Eliezer Brecher

  2. Stanford University School of Medicine, Stanford, CA, USA

    Tej Deepak Azad

  3. Department of Neurosurgery, Kaiser Permanente-The Permanente Medical Group (TPMG), 1150 Veterans Blvd., 3rd Floor Tower, Redwood City, 94063, CA, USA

    Taissa Cherry, Ivan Bernstein, Diana M. Bruce, Stacey Rohrer, Mary William, Eric Sabelman, Gary Heit, Patrick Pezeshkian & Mark Sedrak

  4. Department of Neurosurgery, Northwestern University, Evanston, IL, USA

    Zachary Smith

Authors
  1. Arsani William
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tej Deepak Azad
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eliezer Brecher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Taissa Cherry
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ivan Bernstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Diana M. Bruce
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stacey Rohrer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zachary Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mary William
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Eric Sabelman
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Gary Heit
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Patrick Pezeshkian
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Mark Sedrak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark Sedrak.

Ethics declarations

Funding

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

William, A., Azad, T.D., Brecher, E. et al. Trigeminal and sphenopalatine ganglion stimulation for intractable craniofacial pain—case series and literature review. Acta Neurochir 158, 513–520 (2016). https://doi.org/10.1007/s00701-015-2695-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-015-2695-y

Keywords

Search

Navigation