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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Neuromodulation for the treatment of neuropathic pain of the head and face

Therapieoptionen der Neuromodulation bei neuropathischem Kopf- und Gesichtsschmerz

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  • Leon Niedballa - Universitätsklinikum Düsseldorf, Funktionelle Neurochirurgie und Stereotaxie, Düsseldorf, Deutschland
  • Sebastian Gillner - Universitätsklinikum Düsseldorf, Funktionelle Neurochirurgie und Stereotaxie, Düsseldorf, Deutschland
  • Jan Vesper - Universitätsklinikum Düsseldorf, Funktionelle Neurochirurgie und Stereotaxie, Düsseldorf, Deutschland
  • Philipp Slotty - Universitätsklinikum Düsseldorf, Funktionelle Neurochirurgie und Stereotaxie, Düsseldorf, Deutschland
  • presenting/speaker Guilherme Santos Piedade - Universitätsklinikum Düsseldorf, Funktionelle Neurochirurgie und Stereotaxie, Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocP213

doi: 10.3205/22dgnc529, urn:nbn:de:0183-22dgnc5298

Published: May 25, 2022

© 2022 Niedballa et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Neuropathic pain of the head and face is complex and notoriously difficult to treat. To improve the success rate and subjective satisfaction with the treatment in this difficult population, we re-evaluated long-term outcomes supplemented with telephone interviews of the current status from a single tertiary care center.

Methods: We report on a series of 33 patients with neuropathic facial pain and trigeminal neuralgia treated between 2010 and 2021 with trigeminal PNFS, Ganglion Gasseri stimulation or thermocoagulation, motor cortex stimulation (MCS) and microvascular decompression (MVD). Demographic data, relevant clinical history, clinical outcomes and complications were retrospectively analyzed, and telephone interviews were conducted.

Results: Ten patients were treated with PNFS, five with G. Gasseri stimulation, three with contralateral motor cortex stimulation and 15 with MVD and/or thermocoagulation. Patients treated with PNFS had a mean follow up-time of 6.6 months and reported a mean pain reduction of 47%. In the latest interview the pain reduction reduced to 35.2%. Five patients were treated with G. Gasseri stimulation, this group had a mean follow-up time of 5.5 months. Pain intensity decreased by 62% at last follow-up. In four of these patients, the stimulator was explanted at a later stage due to insufficient pain relief, dislocation or wound-healing problems. The three patients treated with MCS had an average baseline VAS-score of 9.2 and an average of 8.6 in the last interview. Thirteen of the 15 patients with trigeminal neuralgia treated with MVD and/or GG thermocoagulation benefited from it.

Conclusion: The results for PNFS were positive and stable for the duration of follow-up, complications or insufficient pain relief rendered lower patient satisfaction with MCS und G. Gasseri stimulation. MVD and thermocoagulation are very effective in the treatment of trigeminal neuralgia. Neuropathic pain of the head and neck is difficult to classify and especially in non-classic TN cases a variety of therapeutic options exist. Which neuromodulation option is suited best for distinct types of pain has to be further evaluated. Patient with complex face and head pain should be referred to specialized centers.

Figure 1 [Fig. 1], Figure 2 [Fig. 2]