Clinical outcomes and complications of peripheral nerve field stimulation in the management of refractory trigeminal pain: a systematic review and meta-analysis

Abstract

OBJECTIVE Peripheral nerve field stimulation (PNFS) is a tool in the armamentarium of treatment options for trigeminal pain. The efficacy of this modality in mitigating trigeminal pain remains unclear. The aim of this study was to examine the existing literature on PNFS and elucidate pain score outcomes associated with its use in patients with trigeminal pain. METHODS A systematic review and meta-analysis was performed in accordance with the PRISMA framework. The PubMed, Web of Science, and Scopus databases were queried on June 10, 2020. Studies reporting pain outcomes in more than 5 adult patients treated with PNFS for facial pain were included. The primary outcome of the study was the mean difference in the visual analog scale (VAS) score from the last follow-up to baseline, and it was analyzed by an inverse-variance, random-effect model. The risk of bias was assessed using the Newcastle-Ottawa Scale and a funnel plot. RESULTS Of the 4597 studies screened for inclusion, 46 relevant full-text articles were assessed for eligibility. Eleven observational cohort studies from the 46 articles were found to be eligible, and reported on a total of 109 patients. In 86% (94/109) of cases, trial stimulation was successful and followed by a permanent system implantation. VAS scores improved by 75% (mean difference 6.32/10 points, 95% CI 5.38–7.27 points) compared to baseline. Seventy-six percent (42/55) of patients became medication free or required lower doses of medications. The complication rate necessitating surgical revision was estimated at 32% per procedure. CONCLUSIONS These findings support the belief that PNFS provides effective, long-term pain control for trigeminal pain. Statistical heterogeneity was considerable across all studies. Future work should be aimed at conducting double-blind randomized controlled trials to determine the utility of PNFS for treating various forms of trigeminal pain for which limited therapeutic options exist.

Estimulación eléctrica continua para el tratamiento de la neuralgia del trigémino

“…El 15 % de los pacientes con NT tienen esclerosis múltiple. La NT es muy bien diferencias de los demás dolores neuropáticos del nervio trigémino caracterizados por dolor neuropático, pero con un componente continuo, más quemante que paroxístico, y predominando la alodinia y la hiperalgesia sobre los puntos gatillo (1,(16)(17)(18).…”

“…Los autores consideran que la estimulación del ganglio de gasser puede ser el futuro del tratamiento de los dolores neuropáticos del nervio trigémino, pero solo cuando se haya perfeccionado la técnica percutánea y, sobre todo, el sistema de anclaje del electrodo una vez posicionado en el cavum de Meckel a través del foramen oval. Igualmente, solo electrodos con tecnología wifi que no requieren cableado subcutáneo pueden tener futuro (1,18,31,32).…”

Incidence and Management of Hardware-Related Wound Infections in Spinal Cord, Peripheral Nerve Field, and Deep Brain Stimulation Surgery: A Single-Center Study

“…The procedures related to neurostimulators are well tolerated, and the rate of surgical complications is generally relatively low. In previous studies, the rate of complications directly related to the surgery, like hemorrhage, lead malposition, or infections, in DBS was around 8–12% [18, 19] and for SCS and PNFS around 4–18% [20]. A device-related infection is among the most common complications.…”

Microsurgical posterior fossa re-exploration for recurrent trigeminal neuralgia after previous microvascular decompression: common grounds—scarring, deformation, and the “piston effect”

“…It is unclear which therapeutic options may be offered to a patient with recurrent TN-either after previous MVD or after ablative surgery. While several studies have suggested percutaneous trigeminal ganglion ablation (by thermocoagulation, balloon compression or glycerol injection), radiosurgery, or peripheral nerve field stimulation [7,23,33,34], few other studies have advocated repeat microsurgical posterior fossa re-exploration.…”