Subcutaneous Trigeminal Nerve Stimulation to Relieve Neuropathic Facial Pain

Take an anesthetized patient suffering from neuropathic facial pain, in which trigeminal nociceptor fibers in the face relay pain to spinal projection neurons, which transmit signals to the brain.

Mark along the trigeminal branches for electrode implantation.

Insert cannulas to tunnel subcutaneously from the painful facial region to the area above the ear, known as the supraauricular area.

Insert electrodes in the painful region and guide the distal ends to the supraauricular area.

Then, remove the cannula and secure the electrodes.

Create a subcutaneous pocket below the collarbone, known as the infraclavicular site.

Extend the tunnel to this site and pass electrodes through it.

Attach the electrodes to an internal pulse generator, or IPG, secure it to the infraclavicular site, and close the incisions.

The IPG sends electrical signals to stimulate the trigeminal nerve's mechanoreceptors. These fibers activate the spinal inhibitory interneurons, which inhibit projection neurons and reduce pain transmission.

After a patient has carried out a 12-day stimulation trial according to the text protocol, turn the anesthetized patient's head to the side, contralateral to the pain, then place a pillo