Medically intractable neuropathic facial pain is a debilitating disease. According to the 3rd Edition of the International Classification of Headache Disorders, it can result from conditions like multiple sclerosis or mass effect, and can also be linked to post-traumatic or post-herpetic nerve injuries.

In our study, we aim to demonstrate that stimulating the Gasserian ganglion can be an effective method for reducing neuropathic facial pain.

13 patients with medically refractory neuropathic facial pain were enrolled in this study. Pain etiologies were postherpetic (n=3), post-traumatic (n=3), iatrogenic (n=5), and of unknown origin (n=2). Each patient underwent implantation of a custom-made Medtronic 3-contact anchored, curved lead under light sedation, with intraoperative trial stimulation. Precise lead placement via fluoroscopy ensured optimal positioning through the oval foramen, with subsequent tunneling and externalization of lead extensions in the neck. Patients underwent a trial period of up to 3 weeks with an external neurostimulator to assess stimulation efficacy. VAS scores were obtained 3 times a day, with stimulation parameters adjusted accordingly.

11 of the 13 patients completed the trial period successfully. Mean age was 53.84±14.24 years, with a gender distribution of 8 females and 5 males. The average duration of symptoms prior to surgery was 8.69±10.15 years. Preoperative VAS scores of 9.15±0.9 decreased to 2.64±1.5 within the initial two weeks of external neurostimulator testing. At least three months post-surgery, VAS scores remained relatively low with a mean of 2.5±2.27. Stimulation parameters, including amplitude and pulse width, varied within the patient cohort.

While Gasserian ganglion stimulation shows promise as an effective therapeutic intervention for medically refractory neuropathic facial pain, its underlying mechanism warrants further elucidation. Given the need for tailored stimulation parameters, a trial period of up to 3 weeks is recommended before Internal Pulse Generator (IPG) implantation to optimize settings. The outlined method underscores consistent alleviation of neuropathic facial pain within the studied patient cohort. However, recruitment of additional patients is imperative to refine specific parameters tailored to diverse clinical presentations, ultimately establishing disease-specific programming guidelines.