Clinical Letters|Articles in Press

Percutaneously Placed Gasserian Neurostimulation Electrode Migration Into the Quadrigeminal Cistern: Pathophysiological Hypothesis and Report of Successful Repositioning

      Trigeminal neuropathy is defined as facial pain in the distribution(s) of one or more branch(es) of the trigeminal nerve, caused by another disorder and indicative of neural damage. The pain is usually continuous and is described as burning or squeezing. Itching sensations are also common. This condition is difficult to treat with the current pharmacologic armamentarium, and destructive procedures such as, for example, radiofrequency rhizolysis or balloon compression are contraindicated because they most often aggravate the pain. Shelden et al may have been the first to describe trigeminal neurostimulation, albeit of the distal branches and not the Gasserian ganglion (GG) itself. Others have since successfully treated patients with neurostimulation of the supraorbital nerve (V1) and infraorbital (V2) divisions for trigeminal pain, but stimulation of the mandibular division (lingual nerve) is deemed difficult.
      • Talbot C.E.
      • Zhao K.
      • Ward M.
      • Kandinov A.
      • Mammis A.
      • Paskhover B.
      Neuromodulation of the lingual nerve: a novel technique.
      Percutaneous GG neuromodulation is a treatment option for trigeminal neuropathy that has been supported by the literature since its introduction by Steude et al, and should be considered before more invasive techniques like deep brain stimulation or motor cortex stimulation.
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