gms | German Medical Science

Objective: Peripheral nerve field stimulation has been reported to be a promising modality for the treatment of intractable facial pain, mostly of neuropathic origin. However, evidence is sparse. We therefore present our experience with this minimally invasive technique in eight patients.

Method: We retrospectively analyzed the outcome of all patients, who underwent implantation of one or several subcutaneous electrodes for trigeminal nerve field stimulation (Medtronic Pisces Quad Plus, IPG: PrimeAdvanced). All patients were followed up in our outpatient department and/or contacted via telephone.

Results: In eight patients (four male) a stimulation system was implanted after successful trial stimulation. Five patients suffered from idiopathic trigeminal neuralgia (four type 1, one type 2), two from symptomatic trigeminal neuralgia due to multiple sclerosis and one from atypical facial pain without a neuropathic component. Average patient age was 74.3 years (range 57-87), average symptom duration was 11.9 years (range 6-17). Four of the patients had had microvascular decompression surgery before. Average pain intensity was 9.3 out of 10 (range 7-10) preoperatively and 0.6 (range 0-3) postoperatively. Five patients reported complete absence of pain with stimulation. Average follow-up was 10.8 months (range 3-26). In one patient, an electrode malfunction required a revision with excellent results. In another, a dislocation of the IPG occurred which did not compromise the function; the patient did not wish a revision. A third patient required a debridement due to a minor wound healing deficiency. No serious complications and no morbidity arose.

Conclusions: Peripheral nerve field stimulation appears to be a safe and effective treatment option for refractory trigeminal neuropathic pain even in an elderly population with comorbidities and yields a high patient satisfaction. Likewise, a patient with atypical facial pain showed significant reduction in pain intensity.