Motor cortical stimulation for the treatment of trigeminal neuropathic pain secondary to an arteriovenous malformation. A case report.
Introduction: Trigeminal neuropathic pain (TNP) is a syndrome of severe, disabling, constant facial pain arising from the trigeminal nerve or ganglion. Arteriovenous malformations (AVM) are a rare cause of TNP. The limited choices of intervention of TNP include peripheral nerve stimulation, trigemin...
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2023
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/41142 |
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I10-R327-article-41142 |
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Universidad Nacional de Córdoba |
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I-10 |
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R-327 |
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Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Inglés |
| format |
Artículo revista |
| topic |
arteriovenous malformation facial pain motor cortex trigeminal neuralgia corteza motora dolor facial malformaciones arteriovenosas neuralgia del trigémino córtex motor dor facial malformações arteriovenosas neuralgia do trigêmeo |
| spellingShingle |
arteriovenous malformation facial pain motor cortex trigeminal neuralgia corteza motora dolor facial malformaciones arteriovenosas neuralgia del trigémino córtex motor dor facial malformações arteriovenosas neuralgia do trigêmeo Padilla-Lichtenberger, Fernando Casto, Florencia Garavaglia, Federico Villaescusa, Miguel Ciraolo, Carlos Motor cortical stimulation for the treatment of trigeminal neuropathic pain secondary to an arteriovenous malformation. A case report. |
| topic_facet |
arteriovenous malformation facial pain motor cortex trigeminal neuralgia corteza motora dolor facial malformaciones arteriovenosas neuralgia del trigémino córtex motor dor facial malformações arteriovenosas neuralgia do trigêmeo |
| author |
Padilla-Lichtenberger, Fernando Casto, Florencia Garavaglia, Federico Villaescusa, Miguel Ciraolo, Carlos |
| author_facet |
Padilla-Lichtenberger, Fernando Casto, Florencia Garavaglia, Federico Villaescusa, Miguel Ciraolo, Carlos |
| author_sort |
Padilla-Lichtenberger, Fernando |
| title |
Motor cortical stimulation for the treatment of trigeminal neuropathic pain secondary to an arteriovenous malformation. A case report. |
| title_short |
Motor cortical stimulation for the treatment of trigeminal neuropathic pain secondary to an arteriovenous malformation. A case report. |
| title_full |
Motor cortical stimulation for the treatment of trigeminal neuropathic pain secondary to an arteriovenous malformation. A case report. |
| title_fullStr |
Motor cortical stimulation for the treatment of trigeminal neuropathic pain secondary to an arteriovenous malformation. A case report. |
| title_full_unstemmed |
Motor cortical stimulation for the treatment of trigeminal neuropathic pain secondary to an arteriovenous malformation. A case report. |
| title_sort |
motor cortical stimulation for the treatment of trigeminal neuropathic pain secondary to an arteriovenous malformation. a case report. |
| description |
Introduction: Trigeminal neuropathic pain (TNP) is a syndrome of severe, disabling, constant facial pain arising from the trigeminal nerve or ganglion. Arteriovenous malformations (AVM) are a rare cause of TNP. The limited choices of intervention of TNP include peripheral nerve stimulation, trigeminal nucleotomy and motor cortex stimulation. Case report: We present a 56-year-old man who suffered from trigeminal neuropathic pain secondary to nerve compression due to a giant posterior fossa AVM. The pain was refractory to drug treatment. From all the therapeutic options available we declined the microvascular decompression of the trigeminal nerve due to the presence of the giant AVM, or stereotactic radiosurgery because of the AVM´s diffuse nidus. After a multidisciplinary discussion we proposed a minimally invasive, safe and reversible treatment: Motor Cortical Stimulation (MCS). We placed a 16-pole epidural electrode on the right precentral gyrus. The patient had satisfactory pain control with some supplemental medication. No complications or side effects such as seizures, sensory disturbances or infections were presented. Discussion: The limited choices of intervention of TNP include peripheral nerve stimulation, trigeminal nucleotomy and MCS. Henssen et al performed a systematic review where they investigated the effectiveness of MCS and discovered that this is significantly different among different chronic neuropathic orofacial pain disorders. A visual analogue scale (VAS) measured median pain relief of 66.5% was found. Conclusion: MCS should be one more tool to consider in highly selected cases, when other treatments are unfeasible. |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2023 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/41142 |
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I10-R327-article-411422023-12-01T19:41:10Z Motor cortical stimulation for the treatment of trigeminal neuropathic pain secondary to an arteriovenous malformation. A case report. Estimulación cortical motora para el tratamiento del dolor neuropático trigeminal secundario a una malformación arteriovenosa. Reporte de caso. Estimulação cortical motora no tratamento da dor neuropática trigeminal secundária a uma malformação arteriovenosa. Relato de caso. Padilla-Lichtenberger, Fernando Casto, Florencia Garavaglia, Federico Villaescusa, Miguel Ciraolo, Carlos arteriovenous malformation facial pain motor cortex trigeminal neuralgia corteza motora dolor facial malformaciones arteriovenosas neuralgia del trigémino córtex motor dor facial malformações arteriovenosas neuralgia do trigêmeo Introduction: Trigeminal neuropathic pain (TNP) is a syndrome of severe, disabling, constant facial pain arising from the trigeminal nerve or ganglion. Arteriovenous malformations (AVM) are a rare cause of TNP. The limited choices of intervention of TNP include peripheral nerve stimulation, trigeminal nucleotomy and motor cortex stimulation. Case report: We present a 56-year-old man who suffered from trigeminal neuropathic pain secondary to nerve compression due to a giant posterior fossa AVM. The pain was refractory to drug treatment. From all the therapeutic options available we declined the microvascular decompression of the trigeminal nerve due to the presence of the giant AVM, or stereotactic radiosurgery because of the AVM´s diffuse nidus. After a multidisciplinary discussion we proposed a minimally invasive, safe and reversible treatment: Motor Cortical Stimulation (MCS). We placed a 16-pole epidural electrode on the right precentral gyrus. The patient had satisfactory pain control with some supplemental medication. No complications or side effects such as seizures, sensory disturbances or infections were presented. Discussion: The limited choices of intervention of TNP include peripheral nerve stimulation, trigeminal nucleotomy and MCS. Henssen et al performed a systematic review where they investigated the effectiveness of MCS and discovered that this is significantly different among different chronic neuropathic orofacial pain disorders. A visual analogue scale (VAS) measured median pain relief of 66.5% was found. Conclusion: MCS should be one more tool to consider in highly selected cases, when other treatments are unfeasible. Introducción: El dolor neuropático trigeminal (DNT) es un síndrome de dolor facial intenso, incapacitante y constante que surge del nervio o ganglio del trigémino. Las malformaciones arteriovenosas (MAV) son una causa rara de DNT. Las opciones terapéuticas de DNT incluyen la estimulación de los nervios periféricos, la nucleotomía del trigémino y la estimulación cortical motora. Caso clínico: Presentamos el caso de un varón de 56 años con dolor neuropático trigeminal secundario a compresión nerviosa por una MAV gigante de fosa posterior. El dolor era refractario al tratamiento farmacológico. De todas las opciones terapéuticas disponibles, desestimamos la descompresión microvascular del nervio trigémino por la presencia de la MAV gigante, o la radiocirugía estereotáctica, por ser difuso el nido de la MAV. Tras una discusión multidisciplinar propusimos un tratamiento mínimamente invasivo, seguro y reversible: Estimulación cortical motora (ECM). Colocamos un electrodo epidural en el giro precentral derecho. El paciente tuvo un control satisfactorio del dolor con medicación suplementaria. No presentó complicaciones ni efectos secundarios como convulsiones, alteraciones sensoriales o infecciones. Discusión: Las opciones limitadas de intervención de DNT incluyen estimulación nerviosa periférica, nucleotomía trigeminal y ECM. Henssen et al realizaron una revisión sistemática donde investigaron la efectividad de MCS y descubrieron que esto es significativamente diferente entre los diferentes trastornos de dolor orofacial neuropático crónico. Se encontró un promedio de alivio del dolor medida por una escala analógica visual del 66,5%. Conclusión: La ECM debería ser una herramienta más a considerar en casos estrictamente seleccionados donde otros tratamientos no son viables. Introdução: A dor neuropática do trigêmeo (DNT) é uma síndrome de dor facial intensa, incapacitante e constante decorrente do nervo ou gânglio trigêmeo. As malformações arteriovenosas (MAV) são uma causa rara de PNT. As opções limitadas de intervenção do TNP incluem estimulação do nervo periférico, nucleotomia do trigêmeo e estimulação do córtex motor. Relato de caso: Apresentamos um homem de 56 anos que sofria de dor neuropática trigeminal secundária à compressão do nervo devido a uma MAV gigante da fossa posterior. A dor era refratária ao tratamento medicamentoso. De todas as opções terapêuticas disponíveis declinamos a descompressão microvascular do nervo trigêmeo pela presença da MAV gigante, ou a radiocirurgia estereotáxica pelo nidus difuso da MAV. Após discussão multidisciplinar propusemos um tratamento minimamente invasivo, seguro e reversível: Estimulação Cortical Motora (ECM). Colocamos um eletrodo peridural de 16 polos no giro pré-central direito. A paciente apresentou controle satisfatório da dor com alguma medicação suplementar. Não foram apresentadas complicações ou efeitos colaterais como convulsões, distúrbios sensoriais ou infecções. Discussão: As opções limitadas de intervenção do TNP incluem estimulação do nervo periférico, nucleotomia trigeminal e MCS. Henssen et al realizaram uma revisão sistemática onde investigaram a eficácia do MCS e descobriram que isso é significativamente diferente entre diferentes distúrbios de dor orofacial neuropática crônica. Uma escala visual analógica mediu o alívio mediano da dor de 66,5%. Conclusão: A MCS deve ser mais uma ferramenta a ser considerada em casos altamente selecionados, quando outros tratamentos são inviáveis. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2023-09-29 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Texto application/pdf text/html https://revistas.unc.edu.ar/index.php/med/article/view/41142 10.31053/1853.0605.v80.n3.41142 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 80 No. 3 (2023); 275-288 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 80 Núm. 3 (2023); 275-288 Revista da Faculdade de Ciências Médicas de Córdoba; v. 80 n. 3 (2023); 275-288 1853-0605 0014-6722 10.31053/1853.0605.v80.n3 eng https://revistas.unc.edu.ar/index.php/med/article/view/41142/42626 https://revistas.unc.edu.ar/index.php/med/article/view/41142/42692 Derechos de autor 2023 Universidad Nacional de Córdoba http://creativecommons.org/licenses/by-nc/4.0 |