CASE REPORTS   

Chirurgia 2014 June;27(3):155-9

Copyright © 2014 EDIZIONI MINERVA MEDICA

language: English

Trilateral cranial peripheral nerve stimulation. A technical note on indication and procedural details

Mueller O. ¹, Chen B. ¹, Hagel V. ¹, Gaul C. ^{2, 3}, El Hindy N. ¹

¹ Department of Neurosurgery, University Hospital Essen, Essen, Germany; ² Migräne- und Kopfschmerz-Klinik Königsstein, Königsstein, Germany; ³ Department of Neurology Westdeutsches Kopfschmerzzentrum, University Hospital Essen, Essen, Germany

A 56-year old man presented with a history of refractory cluster headache lasting for more than two decades. During the attack the pain spread from the left frontal to the occipital region of the head. Prior to correct diagnosis of cluster headache, he underwent repetitive operations in the left frontal region on misdiagnosis atheroma, which were of no avail. Substances recommended for first and second line therapy of cluster headache as well as neuropathic disorders failed to relieve the pain. Diagnosed with refractory chronic cluster headache, the patient was treated by occipital nerve stimulation. Even though the cluster attacks were under sufficient control afterwards, still the frontal neuropathic pain remained unchanged. After repeated neurolysis failed to ease the pain, neuromodulative therapy was employed using another electrode along the course of the supraorbital nerve. By stimulation of the frontal nerve the patient was initially able to halve his oral morphine medication. Stimulation parameters had to be adjusted repeatedly for the frontal electrode, whilst the occipital nerve stimulation ran solidly with prefixed parameters. Unfortunately, after six months the frontal electrode broke. The patient denied renewal and rather preferred exhairesis of the supraorbital nerve. Neuropathic pain syndromes are a common sequela after repetitive surgical procedures. Those refractory to first and second line drug therapy may well respond to neuromodulative procedures. We present the case of a patient treated with trilateral peripheral nerve stimulation for cluster headache and accompanying neuropathy. With the use of three electrodes we were able to reduce the patient’s pain to a most bearable situation. Indications for occipital nerve stimulation as well as a detailed description of the implantation procedure for frontal electrodes are given.