1. 2012;15;E725-E732A Minimally Invasive Surgical Technique for the Treatment of Posttraumatic Trigeminal Neuropathic Pain with Peripheral Nerve Stimulation
   Case Report
   Sergio Lenchig, MD, Jackson Cohen, MD, and Dennis Patin, MD.

BACKGROUND: Facial pain occurring after traumatic injury of the facial branches of the trigeminal nerve is a medical condition that is often very difficult to treat. Patients are quite disabled by their symptoms and most therapies are ineffective in relieving this pain. Peripheral nerve stimulation has been used as a treatment to provide pain relief for this type of intractable atypical facial pain.

OBJECTIVE: To describe a minimally invasive peripheral nerve stimulation surgical technique for treating posttraumatic trigeminal neuralgia.

STUDY DESIGN: Case report based on a patient seen in a university setting with posttraumatic trigeminal neuropathic pain who underwent a minimally invasive technique for the placement of a peripheral nerve stimulator.

SETTING: University-based outpatient clinic.

METHODS: A patient with a clinical picture suggestive of trigeminal neuropathic pain secondary to trauma involving the V1 and V2 branches of the trigeminal nerve was selected. Conservative management was attempted with no improvement before peripheral nerve stimulation was tried with a minimally invasive surgical technique. We recorded the patient’s subjective assessment of pain and daily function before and after the procedure.

RESULTS: Following the procedure, the patient’s pain score decreased approximately 50% and the patient reported a better quality of life with improvement in daily function as well as a more positive outlook on her condition. There were no complications after the procedure and the patient reported no complaints with the device.

LIMITATIONS: Case report.

CONCLUSIONS: This surgical technique for placing peripheral nerve stimulators allows for a minimally invasive approach for the treatment of intractable posttraumatic trigeminal neuralgia with potentially less risk of facial nerve damage. This case confirms the need for further studies to be done in the future to prove the safety and effectiveness of this technique.