Neurosurgery Practice 2026;7(1):e000191.
This case report describes successful percutaneous trigeminal ganglion stimulation (TGS) in a 71-year-old woman with anesthesia dolorosa (AD) after multiple rhizotomies for trigeminal neuralgia related to multiple sclerosis. The authors detail implantation technique, trial and permanent lead placement, stimulation parameters, and sustained clinical improvement over three years without major complications.
The article situates TGS within neuromodulation strategies for refractory deafferentation pain, reviews prior peripheral nerve stimulation evidence, and discusses mechanisms, patient selection considerations, and hardware anchoring challenges. The authors conclude TGS is a promising option for refractory AD and call for further research to refine indications and device fixation.
Condition Anesthesia dolorosa (AD) is a rare, debilitating deafferentation pain syndrome (incidence ~0.3%–2%) that often follows iatrogenic trigeminal nerve injury such as trigeminal rhizotomy and is frequently refractory to medications.
Patient case A 71-year-old woman with trigeminal neuralgia secondary to multiple sclerosis developed severe, medically refractory AD after multiple rhizotomies, with burning jaw pain and substantial numbness that impaired eating, talking, and oral hygiene.
Intervention An off-label percutaneous trigeminal ganglion stimulation (TGS) externalized trial was offered because some sensation was preserved.
Procedure Under fluoroscopic guidance, an electrode was advanced via a Jamshidi needle through the foramen ovale to the trigeminal ganglion region and secured on the cheek/postauricular area; an external generator was connected for the trial.
Trial outcome Over ~2 weeks of continuous stimulation, pain during episodes improved from 9/10 to 0–1/10, and relief persisted until permanent implantation 2 months later.
Durability After permanent implantation (St. Jude Octrode lead; generator in left chest wall), the patient reported 0–1/10 burning pain with return to baseline activities, with stable relief for 3 years with minimal setting adjustments alongside baclofen and pregabalin.
Rationale TGS is proposed to help restore tonic signaling to the trigeminal nucleus to rebalance excitatory/inhibitory processing and alleviate pain, potentially even with severe peripheral deafferentation.
Implications/limits This single case supports TGS as a promising option for refractory AD and warrants further investigation; practical challenges include achieving robust facial lead anchoring and defining optimal indications/trial criteria.
You must be logged in to post a comment.