Algoritmo para el tratamiento quirúrgico del dolor facial

Slavin Konstantin V; Hrachya  Nersesyan; Mustafa E Colpan; Naureen  Munawar

doi:10.47924/neurotarget2007366

Authors

Konstantin V Slavin University of Illinois Chicago Medical Center, Chicago, IL.
Hrachya Nersesyan University of Illinois Chicago Medical Center, Chicago, IL.
Mustafa E Colpan University of Illinois Chicago Medical Center, Chicago, IL.
Naureen Munawar University of Illinois Chicago Medical Center, Chicago, IL.

DOI:

https://doi.org/10.47924/neurotarget2007366

Keywords:

Facial pain, treatment, algorithm

Abstract

Background: Facial pain may be divided into several distinct categories, each requiring a specific

treatment approach. In some cases, however, such categorization is difficult and treatment is ineffective. We reviewed our extensive clinical experience and designed an algorithmic approach to the treatment of medically intractable facial pain that can be treated through surgical intervention.

Patients and methods: Our treatment algorithm is based on taking into account underlying pathological processes, the anatomical distribution of pain, pain characteristics, the patient’s age and medical condition, associated medical problems, the history of previous surgical interventions, and, in some cases, the results of psychological evaluation. The treatment modalities involved in this algorithm include diagnostic blocks, peripheral denervation procedures, craniotomy for microvascular decom- pression of cranial nerves, percutaneous rhizotomies using radiofrequency ablation, glycerol injection, balloon compression, peripheral nerve stimulation procedures, stereotactic radiosurgery, percutaneous trigeminal tractotomy, and motor cortex stimulation. We recommend that some patients not receive surgery at all, but rather be referred for other medical or psychological treatment.

Results: Our algorithmic approach was used in more than 100 consecutive patients with medically intractable facial pain. Clinical evaluations and diagnostic workups were followed in each case by the systematic choice of the appropriate intervention. The algorithm has proved easy to follow, and the recommendations include the identification of the optimal surgery for each patient with other options reserved for failures or recurrences. Our overall success rate in eliminating facial pain presently reaches 96%, which is higher than that observed in most clinical series reported to date.

Conclusions: This treatment algorithm for the intractable facial pain appears to be effective for patients with a wide variety of painful conditions and may be recommended for use in other institutions.

Metrics

Metrics Loading ...

References

Slavin KV, Burchiel KJ. Surgical options for facial pain. In: K.J. Burchiel, editor. Surgery for Pain. New York: Thieme Medical; 2002. p. 849-64.

Burchiel KJ, Slavin KV. On the natural history of trigeminal neuralgia. Neurosurgery. 2000;46(1):152-4; discussion 154-5.

Burchiel KJ. A new classification for facial pain. Neurosurgery. 2003 Nov;53(5):1164-6; discussion 1166-7.

Eller JL, Raslan AM, Burchiel KJ. Trigeminal neuralgia: definition and clas- sification. Neurosurg Focus. 2005 May 15;18(5):E3.

Amirnovin R, Neimat JS, Roberts JA, Eskandar EN. Multimodality treatment of trigeminal neuralgia. Stereotact Funct Neurosurg. 2005;83(5-6):197-201.

Osenbach R. Neurostimulation for the treatment of intractable facial pain. Pain Med. 2006;7 Suppl 1:S126-36.

Slavin KV, Nersesyan H. Prospective study of natural history of facial pain: a technical description. J Pain. 2005;6 Suppl 1: S30.

Ogleznev KYa , Grigoryan YuA , Slavin KV. Parapontine epidermoid tumours presenting as trigeminal neuralgias: anatomical findings and operative results. Acta Neurochir. (Wien) 1991;110(3-4):116-9.

Slavin KV, Wess C. Trigeminal branch stimulation for intractable neuropathic pain: Technical note. Neuromodulation. 2005;8(1):7-13.

Slavin KV, Colpan ME, Munawar N, Wess C, Nersesyan H. Trigeminal and occipital peripheral nerve stimulation for craniofacial pain: a single-institution experience and review of the literature. Neurosurg Focus. 2006;21(6):E5.

Kanpolat Y, Deda H, Akyar S, Cağlar S, Bilgiç S. CT-guided trigeminal tractotomy. Acta Neurochir (Wien) 1989;100(3-4):112-4.

Grigoryan YuA, Slavin KV, Ogleznev KYa. Ultrasonic lesion of the trigeminal nucleus caudalis for deafferentation facial pain. Acta Neurochir. (Wien) 1994;131(3-4):229-35.

Henderson JM, Lad SP. Motor cortex stimulation and neuropathic facial pain. Neurosurg Focus. 2006;21(6):E6.

Osenbach RK. Motor cortex stimulation for intractable pain. Neurosurg Focus. 2006;21(6):E7.

Slavin KV, Thulborn K. Motor cortex stimulator implantation guided by combination of frameless navigation and intraoperative neurophysiology. In: Proceedings of the 2nd International Scientific Teleconference “New Technology in Medicine”; 2005 March; St-Petersburg, Russia; 2005. p. 72-3.

Slavin KV. Glossopharyngeal neuralgia. Seminars in Neurosurgery. 2004;15(1):71-9.

Slavin KV. Eagle syndrome: entrapment of the glossopharyngeal nerve? Case report and review of the literature. J Neurosurg. 2002;97(1):216-8.