Trigeminal Ganglion Stimulation.

Facial pain in the distribution of the trigeminal nerve, commonly identified as trigeminal neuralgia, should not be confused with trigeminal neuropathic pain. The latter is caused by an accidental and nonintentional nerve lesion. When the first-line pharmacological treatment fails to provide satisfactory pain relief, surgical treatment, such as microvascular decompression and neurodestructive interventions (radiofrequency or cryotherapy), is not indicated. The logical choice of technique becomes neuromodulation, but it may be challenging to perform in the facial area. Although the initial results of trigeminal ganglion stimulation were promising, they often were of short duration because of lead migration and inadequate stimulation coverage in the trigeminal nerve distribution. To ensure accurate placement and proper anchoring, a custom-made electrode was developed and produced, and its stereotactic implantation is guided by electromagnetic navigation. This technique has been used at our center for several years; the published results show at least 30% of pain relief in 75% of the patients and considerable reduction in medication use.