Deep Brain Stimulation of the Ventroposteromedial (VPM) Thalamus 10 Years after VPM Thalamotomy to Treat a Recurrent Facial Pain.

We report the successful treatment of recurrent facial pain by deep brain stimulation (DBS) of the ventroposteromedial thalamic nucleus (VPM-DBS), 10 years after VPM thalamotomy. A 62-year-old woman who suffered from an atypical right-sided trigeminal neuralgia of the V1 and V2 branches was successfully treated a decade ago with a radiofrequency VPM thermocoagulation. Ten years later, the same burning right-sided trigeminal pain progressively recurred and was resistant to medical treatments. A DBS procedure was proposed to the patient aiming to stimulate the vicinity of the preexisting stereotactic lesion. Intraoperatively, the pain relief was immediate at low stimulation intensities. Eleven months later, the patient remains pain free. This case report suggests that DBS targeting an area of the VPM close to the previous stereotactic lesion is possible as a salvage therapy, and can successfully achieve relief of facial pain 10 years after VPM thalamotomy.