Artikel
Wireless subcutaneous trigeminal nerve field stimulation for refractory trigeminal pain – a single-centre experience
Drahtlose periphere Nervenstimulation bei refraktärer Trigeminusneuralgie
Suche in Medline nach
Autoren
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Mohammad Mehdi Hajiabadi
- Heidelberg University Hospital, Department of Neurosurgery, Heidelberg, Deutschland
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Martin Jakobs
- Heidelberg University Hospital, Department of Neurosurgery, Heidelberg, Deutschland
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Andreas W. Unterberg
- Heidelberg University Hospital, Department of Neurosurgery, Heidelberg, Deutschland
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Rezvan Ahmadi
- Heidelberg University Hospital, Department of Neurosurgery, Heidelberg, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: Subcutaneous trigeminal nerve field stimulation (sTNFS) is a neuromodulatory treatment for neuropathic trigeminal pain with the ability to reduce the intensity and frequency of pain attacks. However, the published case series of sTNFS report hardware issues including lead migration, skin erosion, infection, so- called pocket pain at the site of the implanted neurostimulator. Furthermore, traditionally used systems are not MR-compatible. New wireless neuromodulation technology, promises not only an even less invasive sTNFS treatment and thinner electrodes better suited for facial implants, but also provides further advantages such as lack of an implantable neurostimulator and 3-T MRI compatibility.
Methods: All patients received stimulation with subcutaneous leads in the concerned trigeminal regions that were connected wirelessly to an extracorporeal neurostimulator. During the follow-up VAS-scores, attack rates, oral pain medication, complications and side effects of sTNFS were recorded and documented.
Results: According to the 3rd edition of the International Classification of Headache Disorders (ICHD-3) N=2 of the patients were classified with TN with concomitant persistent facial pain and N=1 patient with multiple sclerosis associated TN. All three patients received at least 24 days of stimulation with subcutaneous leads in the concerned trigeminal regions that were connected wirelessly to an extracorporeal neurostimulator. All patients (n = 3) responded to sTNFS (i.e. ≥50 % pain reduction) during the test period. The time of the test period was 44 ± 31.24 days (mean ± SD). The length of stimulation per patient per day amounted 2.5 ± 2.2 hours (mean ± SD). The pain intensity (as defined by VAS) was reduced by 80% ± 17 % (mean ± SD). Reduction or cessation in pain medication was observed in all patients. No surgical complications occurred in the long-term follow-up period of 18.84 ± 6 (mean ± SD) months.
Conclusion: The new wireless sTNFS device is a safe, effective and reliable therapy with apparently few complications. Compared to conventional devices, the equipment permits longer trial stimulation periods. Furthermore, the daily stimulation duration was much shorter compared to previous reports.
