Neuromodulación quirúrgica eléctrica y dolor. Estimulación del ganglio de Gasser para la neuropatía trigeminal crónica

Oscar A. Stella; César Sereno

doi:10.47924/neurotarget2015257

Authors

Oscar A. Stella FLENI Institute, Buenos Aires, Argentina.
César Sereno FLENI Institute, Buenos Aires, Argentina.

DOI:

https://doi.org/10.47924/neurotarget2015257

Keywords:

trigeminal neuralgia, neuropathy, Gasser ganglion stimulation

Abstract

Introduction: Trigeminal nerve injury is associated with chronic trigeminal neuropathy, which is a chronic facial pain; it is manifested as hypesthesia, dysesthesia, hyperalgesia and allodynia, unresponsive to carbamazepine, analgesics and / or antidepressants. Ablative surgical procedures are usually ineffective too. Gasser ganglion electrical stimulation is an interesting therapeutic option for the chronic trigeminal neuropathies.
Material and method: Our study population consists of four female patients, who were operated on between 2006 and 2011 and suffered from painful chronic trigeminal neuropathy with facial hypoesthesia. Two of them had previously undergone trigeminal radiofrequency thermolesion; third one had undergone two neurovascular decompression interventions due to post maxillary traumatic residual pain. And the latter one had a previous iatrogenic history of nine diverse procedures for “typical” trigeminal neuralgia. In all cases we used a DBS quadripolar electrode model 3389 ® (Medtronics©, Minneapolis, MN), implanted into the root-gasserian ganglion complex and underwent internalization of the electrode after intraoperative trial stimulation of a few minutes (to achieve the appearance of paresthesias in the facial area affected and a 50% decrease in pain intensity).
Results and discussion: The follow-up was at 68, 18, 24 and 3 months, respectively. The average pain relief was 70%, according to the visual analogue scale (VAS); drug intake decreased significantly and achieved a positive impact on quality of life (SF-36). Surgical complications were: caudal migration electrode (two cases; the electrodes were relocated) and postoperative infection of pocket containing generator (a case; the system was removed, antibiotic treatment was initiated and it was replaced by a fixed sacral stimulation electrode).
Conclusion: Chronic stimulation of the Gasser ganglion is a therapeutic alternative simple, safe, reversible and effective for suffering for painful chronic trigeminal neuropathies, especially if the affected trigeminal branch is V3. A larger number of cases are necessary for definitive conclusions.

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References

Shelden CH. Depolarization in the treatment of trigeminal neuralgia: Evaluation of compression and electrical methods; clinical concept of neurophysiological mechanism. In: Knighton RS, Dumke PR, editors. Proceedings of the Henry Ford Hospital International Symposium on Pain. 21-23 Oct 1964, Detroit. Boston (Mass): Little, Brown and Company; 1966.

Shelden CH, Pudenz RH, Doyle J. Electrical control of facial pain. Am J Surg 1967;114(2)209-12.

Wall PD, Sweet WH. Temporary abolition of pain in man. Science 1967;155(758):108-9.

Sweet WH. Control of pain by focal electrical stimulation for supression. Ariz Med 1969;26(12):1042-5.

Sweet WH, Wepsic JG.Treatment of chronic pain by stimulation of fibers of primary afferent neuron. Trans Am Neurol Assoc 1968;93:103-7.

Hall GC, Carroll D, Parry D, McQuay HJ. Epidemiology and treatment of neuropathic pain: the UK primary care perspective. Pain 2006;122(1-2):156-62.

Rainov NG, Heidecke V. Motor cortex stimulation for neuropathic facial pain. Neurol Res 2003;25(2):157-61.

Raslan AM, Nasseri M, Bahgat D, Abdu E, Burchiel KJ. Motor cortex stimulation for trigeminal neuropathic or deafferentation pain: an institutional case series experience. Stereotact Funct Neurosurg 2011;89(2):83-8.

Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965;150(3699):171-9.

Baldry PE. Acupuncture, trigger points and musculoskeletal pain: a scientific approach to acupuncture for use by doctors and physiotherapists in the diagnosis and management of myofascial trigger point pain. 3rd ed. Edinburgh, New York: Elsevier/Churchill Livingstone; 2005.

Le Bars D, Dickenson AH, Besson JM. Diffuse noxious inhibitory controls (DNIC). I. Effects on dorsal horn convergent neurones in the rat. Pain 1979;6(3):283-304.

Kerr FW. The ultrastructure of the spinal tract of the trigeminal nerve and the substantia gelatinosa. Exp Neurol 1966;16(4):359-76.

Taub E, Munz M, Tasker RR. Chronic electrical stimulation of the gasserian ganglion for the relief of pain in a series of 34 patients. J Neurosurg 1997;86(2):197-202.

Piovesan EJ, Kowacs PA, Oshinsky ML. Convergence of cervical and trigeminal sensory afferents. Curr Pain Headache Rep 2003;7(5):377-83.

Broggi G, Franzini A, Ferroli P. Trigeminal stimulation. In: Burchiel K, editor. Surgical management of pain. New York: Thieme Medical Publisher, 2002; p. 903-7.

Matharu MS, Bartsch T, Ward N, Frackowiak RS, Weiner R, Goadsby PJ. Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study. Brain 2004;127(Pt 1):220-30.

Le Doaré K, Akerman S, Holland PR, Lasalandra MP, Bergerot A, Classey JD, et al. Occipital afferent activation of second order neurons in the trigeminocervical complex in rat. Neurosci Lett 2006;403(1-2):73-7.

Willoch F, Gamringer U, Medele R, Steude U, Tölle TR; PET activation study. Analgesia by electrostimulation of the trigeminal ganglion in patients with trigeminopathic pain: a PET activation study. Pain 2003;103(1-2):119-30.

Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Treatment of thalamic pain by chronic motor cortex stimulation. Pacing Clin Electrophysiol 1991;14(1):131-4.

Brown JA, Pilitsis JG. 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 2005;56(2):290-7.

Peyron R, Faillenot I, Mertens P, Laurent B, Garcia-Larrea L. Motor cortex stimulation in neuropathic pain. Correlations between analgesic effect and hemodynamic changes in the brain. A PET study. Neuroimage 2007;34(1):310-21.

Hosobuchi Y. Subcortical electrical stimulation for control of intractable pain in humans. Report of 122 cases (1970-1984). J Neurosurg 1986;64(4):543-53.

Levy RM, Lamb S, Adams JE. Treatment of chronic pain by deep brain stimulation: long term follow-up and review of the literature. Neurosurgery 1987;21(6):885-93.

Jeanmonod D, Magnin M, Morel A. Chronic neurogenic pain and the medial thalamotomy. Schweiz Rundsch Med Prax 1994;83(23):702-7.

Hamani C, Schwalb JM, Rezai AR, Dostrovsky JO, Davis KD, Lozano AM. Deep brain stimulation for chronic neuropathic pain: long-term outcome and the incidence of insertional effect. Pain 2006;125(1-2):188-96.

Levy R, Deer TR, Henderson J. Intracranial neurostimulation for pain control: a review. Pain Physician 2010;13(2):157-65.

Schvarcz JR. Spinal cord stereotactic techniques trigeminal nucleotomy and extralemniscal myelotomy. Appl Neurophysiol 1978;41(1-4):99-112.

Schvarcz JR. Craniofacial postherpetic neuralgia managed by stereotactic spinal trigeminal nucleotomy. Acta Neurochir Suppl (Wien) 1989;46:62-4.

Teixeira MJ, Lepski G, Aguiar PH, Cescato VA, Rogano L, Alaminos AB. Bulbar trigeminal stereotactic nucleotractotomy for treatment of facial pain. Stereotact Funct Neurosurg 2003;81(1-4):37-42.

Davis KD, Hutchison WD, Lozano AM, Dostrovsky JO. Altered pain and temperature perception following cingulotomy and capsulotomy in a patient with schizoaffective disorder. Pain 1994;59(2):189-99.

Hassenbusch SJ, Pillay PK, Barnett GH. Radiofrequency cingulotomy for intractable cancer pain using stereotaxis guided by magnetic resonance imaging. Neurosurgery 1990;27(2):220-3.

Pillay PK, Hassenbusch SJ. Bilateral MRI-guided stereotactic cingulotomy for intractable pain. Stereotact Funct Neurosurg 1992;59(1-4):33-8.

Wong ET, Gunes S, Gaughan E, Patt RB, Ginsberg LE, Hassen-busch SJ, et al. Palliation of intractable cancer pain by MRI-guided cingulotomy. Clin J Pain 1997;13(3):260-3.

Stella O, Morello F, Condomí Alcorta S, Salvat J. Neuromodulación quirúrgica eléctrica y dolor. Revisión y estado actual. Arch Neurol Neuroc Neuropsiquiatr 2008;15(2)34-44.

Cook AW, Zandieh M, Baggenstos P, et al. Radiofrequency stimulation of the trigeminal complex in tic douloureux and atypical facial neuralgia: temporary percutaneous and permanent methods. Acupunct Electrother Res 1978;3:37-47.

Steude U. 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 (Wien) 1984;33:481-6.

Meyerson BA, Håkansson S. Alleviation of atypical trigeminal pain by stimulation of the Gasserian ganglion via an implanted electrode. Acta Neurochir Suppl (Wien) 1980;30:303-9.

Meyerson BA, Håkanson S. Suppression of pain in trigeminal neuropathy by electric stimulation of the gasserian ganglion. Neurosurgery 1986;18(1):59-66.

Sweet WH, Wepsic JG. Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. 1. Trigeminal neuralgia. J Neurosurg 1974;40(2):143-56.

Zountsas V, Puchner MJA, Hoff HJ, Oppel F. Langzeit-Ergebnisse der N.Trigeminus-Stimulation bei Patienten mit Trigeminus neuralgie nicht ansprechend auf mikrovaskuläre Dekompression [Long-term results of trigeminal nerve stimulation in patients with trigeminal neuralgia non-responding to previous microvascular decompression]. [Article in Deutsch] Proceedings of the 56th Annual Meeting of the Society for Neurosurgery (DGNC) and 3rd French Journees of Neurosurgery (SFNC). 7-11 May 2005. Strasbourg, France: French Society of Neurosurgery and German Society of Neurosurgery; 2005.

Probst C. Traitement des névralgies faciales atypiques post-traumatiques et postopératoires par stimulation chronique. Apropos de deux cas, avec revue de la littérature [Treatment of atypical post-traumatic and postoperative facial neuralgias by chronic stimulation. Apropos of 2 cases, with review of the literature]. [Article in French] Neurochirurgie 1988;34(2):106-9.

Steude U. Chronic trigeminal nerve stimulation for the relief of persistent pain. In: Gildenberg PL, Tasker RR, editors. Textbook of stereotactic and functional neurosurgery. New York: McGraw- Hill; 1998. p. 1557-64.

Mehrkens JH, Steude U. Elektrostimulation im Ganglion Gasseri (TGES) bei Trigeminusneuropathie nach (iatrogener) Läsion des Nervus Trigeminus: Ergebnisse aus über 25 Jahren Erfahrung [Electro stimulation of the trigeminal ganglion (TGES) in patients with trigeminopathic pain after (iatrogenic) lesion of the trigeminal nerve: results from over 25 years of experience]. [Article in Deutsch] Proceedings of the 56th Annual Meeting of the Society for Neurosurgery (DGNC) and 3rd French Journees of Neurosurgery (SFNC). 7-11 May 2005. Strasbourg, France: French Society of Neurosurgery and German Society of Neurosurgery; 2005.

Mehrkens JH, Steude U. Chronic electrostimulation of the trigeminal ganglion in trigeminal neuropathy: current state and future prospects. Acta Neurochir Suppl 2007;97(Pt 2):91-7.

Cheshire WP. Trigeminal neuralgia: for one nerve a multitude of treatments. Expert Rev Neurother 2007;7(11):1565-79.

Ferner H. On the anatomy of the intracranial segments of the trigeminal nerve. [Article in German] Z Anat Entwicklungsgesch 1948;114:108-22.

Lang J. Neuroanatomie der Nn. opticus, trigeminus, facialis, glossopharyngeus, vagus, accessorius und hypoglossus [Neuroanatomy of the optic, trigeminal, facial, glossopharyngeal, vagus, accessory and hypoglossal nerves]. [Article in German] Arch Otorhinolaryngol 1981;231(1):1-69.

Lang, J. (1983) Clinical Anatomy of the Head. Neurocranium, orbit and craniocervical regions. Berlin: Springer-Verlag; 1983. p. 186-203.

Chui M, Tucker W, Hudson A, Bayer N. High resolution CT of Meckel's cave. Neuroradiology 1985;27(5):403-9.

Rubinstein D, Stears RL, Stears JC. Trigeminal nerve and ganglion in the Meckel cave: appearance at CT and MR imaging. Radiology 1994;193(1):155-9.

Franzini A, Messina G, Cordella R, Marras C, Broggi G. Deep brain stimulation of the posteromedial hypothalamus: indications, long-term results, and neurophysiological considerations. Neurosurg Focus. 2010 Aug;29(2):E13.

Cioni B, Meglio M. Motor cortex stimulation for chronic non-malignant pain: current state and future prospects. Acta Neurochir Suppl 2007;97(Pt 2):45-9.

Lazorthes Y, Sol JC, Fowo S, Roux FE, Verdié JC. Motor cortex stimulation for neuropathic pain. Acta Neurochir Suppl 2007;97(Pt 2):37-44.

Barolat G, Knobler RL, Lublin FD. Trigeminal neuralgia in a patient with multiple sclerosis treated with high cervical spinal cord stimulation. Case report. Appl Neurophysiol 1988;51(6):333-7.

Tomycz ND, Deibert CP, Moossy JJ. Cervicomedullary junc- tion spinal cord stimulation for head and facial pain. Headache 2011;51(3):418-25.

Chang P, Levy RM. High lateral cervical spinal cord stimulation (SCS) for neuropathic facial pain: report of 10 cases. Proceedings of the 2010 Congress of Neurological Surgeons Annual Meeting. 16-21 Oct 2010. San Francisco, California: Congress of Neurological Surgeons; 2010. p. 943.