Subcutaneous Trigeminal Nerve Stimulation to Relieve Neuropathic Facial Pain

Abstract

Source: Jakobs, M., et al. Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain. J. Vis. Exp. (2017)

This procedure demonstrates the implantation of subcutaneous electrodes for trigeminal nerve stimulation to treat neuropathic facial pain. The electrodes are tunneled subcutaneously from the affected facial region to an infraclavicular pocket, where they are connected to an internal pulse generator (IPG). The IPG delivers electrical stimulation, activating mechanoreceptor fibers, which in turn stimulate inhibitory interneurons in the spinal cord, thereby reducing pain transmission to the brain.

Protocol

All procedures involving human participants have been performed in compliance with the institutional, national, and international guidelines for human welfare and have been reviewed by the local institutional review board.

1. Implantation of Permanent Electrodes and internal pulse generator (IPG)

1. Place the patient in a supine position under general anesthesia. Turn the head to the contralateral side of the pain. Place a pillow under the ipsilateral shoulder to expose the clavicle.
2. Administer intravenous single-shot antibiotics (e.g., 2 g cephazoline) 20 min before the start of the procedure.
3. Shave the area around the ear of the pain....

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
myStim Patient Programmer	Medtronic	97740	enables the patient to turn off and on stimulation
Prime Advanced	Medtronic	97702	non-rechargeable IPG as powersource for stimulation
Restore Ultra	Medtronic	97712	rechargeable IPG as powersource for stimulation
Charging System	Medtronic	97754	used by the patient to recharge the Restore Ultra IPG
N'Vision Programmer	Medtronic	8840	used by the physician to program the IPG and define stimulation parameters
External Neurostimulator	Medtronic	37022	external IPG as powersource for trial stimulation with externalized electrodes
Advanced Screening Cable	Medtronic	355531	connects externalized electrodes to the external neurostimulator during trial stimulation
Tunnelling Spear 60cm	Medtronic	3655-60	used to subcutaneously tunnel the permanent electrodes to an infraclavicular pocket that houses the IPG
Tunnelling Spear 38cm	Medtronic	3655-38	used to subcutaneously tunnel the permanent electrodes to an infraclavicular pocket that houses the IPG
Tuhoy Cannula	Medtronic	3550-32	14 gauge Epidural Tuhoy cannula (length 9cm) to subcutaneously implant the electrodes
InjexFixation Device	Medtronic	97791 / 97792	used to fixate the electrodes on the skin or on the muscle fascia
Octad Compact	Medtronic	3878-60	permanent electrode (length 60cm) implanted in the subcutaneous tissue with 8 contacts
Vectris Trial Lead	Medtronic	977D260	externalized electrode (length 60cm) used during the stimulation trial
Ethilon*II 3-0	Ethicon	EH7933H	non-absorbable suture for skin closure
Seide 2-0	Resorba	40221	non-absorbable silk suture to fixate electrodes and IPG
Resolon DS21	Resorba	881413	absorbable suture for subcutaneous wound closure
Feather disposable scalpel	Feather	5205052	single use scalpel for skin incision and suture cutting
Scandicain 1%	Astra Zeneca	23186	1% Mepivacain solution for local anesthesia
Cosmopor E steril 10x6	Hartmann	900871	Sterile draping for IPG wound
Cosmopor E steril 7,2x5	Hartmann	900870	Sterile draping for skin punctures and small incisions
Foliodrape Comfort 50x50	Hartmann	252302	Sterile draping for the surgical field
Cephazolin	Fresenius	6062403.00.00	Single shot perioperative antibiotic
Kepinol forte 800mg/160mg	Dr. R. Pfleger Chemische Fabrik	2485177	Postoperative prophylactic oral antibiotic
Poly-Alcohol	Antiseptica	UN1219	Coloured skin disinfectant used during the permanent implantation
Cutasept F	Bode	976800	Un-Coloured skin disinfectant used during the trial implantation