Surgical Treatments for Facial
Neurostimulation is a medical treatment for people suffering from chronic
pain, including Trigeminal Neuralgia and other facial neuralgias. A small
device, much like a pacemaker delivers low voltage electrical stimulation to the
spinal cord or targeted peripheral nerve to block the sensation of pain. Once
experimental, this treatment is being used more often to treat intractable
||This is an example of
what a neurostimulation device looks like.
Whitworth from the University of Texas, Southwestern Center in Dallas there
are five types of Neurostimulation that can be of help to facial pain patients.
Peripheral Nerve Stimulation, Ganglion Nerve Stimulation, Spinal Chord
Stimulation, Deep Brain Stimulation and Motor Cortex Stimulation.
- Peripheral Nerve Stimulation
In Peripheral Nerve Stimulation, sometimes referred to as PENS, a thin
electrical lead is inserted into the cheek, lip or other area of the face..
The electrical lead is positioned into the face using a CT scanner. Once
positioned, the lead is connected to an external neurostimulator which sends
low level electrical pulses through the lead to the face which is felt as a
slight tingling, burning or itching. A trial period of 1-10 days using the
neurostimulator externally typically follows. Once the neurostimulator
is adjusted and found to be effective, a second surgical procedure is done to
implant the complete neurostimulator system.
According to Dr. Whitworth, this procedure is
most beneficial for patients with "pain in the Trigeminal Nerve branch V1
(eye, forehead, nose) or V2
(upper teeth, gums and lip,
the cheek, lower eyelid and the side of the nose)
and requires at least some remaining sensation in the pain region."
Stimulation: Department of Neurosurgery Oregon Health and Science
experience with Peripheral Nerve Stimulation
- Ganglion Stimulation
According to Dr. Whitworth, this procedure "Can treat pain in any
trigeminal distribution but has a high rate of dislodgement, 50% at one year."
- Spinal Cord Stimulation
According to Dr. Whitworth, this procedure "Uses a very stable
electrode, is good for treating pain in the V3 (lower
teeth, gums and lip) and requires some
- Deep Brain Stimulation
In this surgical procedure, thin electrodes are inserted through the skull
into the thalamus, the area of the brain where pain signals are sensed. After
a trial period, if there is significant improvement with the pain level, the
device is implanted into the body. According to "Striking Back,
The Trigeminal Neuralgia and Face Pain Handbook, "The average success rate
in the past four years is only 25-35%, although those figure have improved
with experience in recent years."
According to Dr. Whitworth, this procedure is "Good for pain in any
trigeminal distribution, does not require intact sensation, offers at best a
50% success rate. It is often used to treat anesthesia dolorosa,
trigeminal neuropathic pain, and trigeminal deafferentation pain."
- Motor Cortex Stimulation
Motor cortex stimulation (MCS) is a surgical option reserved for patients
with trigeminal neuralgia pain which proves difficult to alleviate. This procedure involves stimulation of the region of the outer
portion of the brain (motor cortex). See Motor
According to Dr. Whitworth, this procedure
is "– Good for pain in any trigeminal distribution, doesn’t require intact
sensation, and its success rate runs 60-70%. It was developed 10-12 years ago
in Japan and has only been used in the US for 5-6 years. It is often used to
treat anesthesia dolorosa, trigeminal neuropathic pain, and trigeminal
Neurosurgery Oregon Health and Science
Neurostimulation for the Treatment of Intractable Facial Pain by Richard