Unusual Cause of Trigeminal Neuralgia: First Report of Intracranial Migration of Spinal Cord Stimulator.

BACKGROUND

Spinal cord stimulation has been shown to be an effective treatment for some patients diagnosed with chronic pain and failed back syndrome. However, lead migration from the implantation site is a potential complication that may reduce treatment efficacy, produce unintended symptoms, and require invasive and costly surgical replacement or removal.

CASE DESCRIPTION: A 71-year-old woman presented to the emergency department with diffuse headache and burning left-sided facial pain consistent with trigeminal neuralgia. She had a history of chronic regional pain syndrome that had been successfully treated for 8 years with a percutaneous spinal cord stimulator, and 2 weeks before presentation she had had the cervical lead replaced. Computed tomography demonstrated intradural and intracranial migration of the cervical lead, which had traversed along the left lateral aspect of the medulla and terminated at the pontomedullary junction. The migrated cervical lead was removed surgically. At follow-up, her trigeminal pain had resolved.

CONCLUSIONS

Although spinal cord stimulation has demonstrated effectiveness as a treatment for chronic pain, care must be taken to ensure that the spinal cord stimulator leads are properly placed within the epidural space and are firmly anchored to avoid migration. Intracranial migration of a spinal cord stimulator lead poses significant risks for injury to adjacent cortical structures and may produce pain syndromes including trigeminal neuralgia.