Papers of the Week

Trigeminal neuralgia is considered the worst pain a human being can experience. Initial treatment utilizes anticonvulsant sodium channel blockers, which relieve pain in approximately 70% of patients. In refractory cases, it is possible to perform ablative treatments decompressive surgeries and neuromodulatory techniques. This report describes the treatment of a patient with refractory trigeminal neuralgia, remaining with a painful clinical picture after four surgical procedures and three ablative procedures. A dorsal root ganglion (DRG) stimulation electrode was implanted in the trigeminal ganglion, through intraoral puncture with maxillary fixation of the electrode, in order to minimize the chances of displacement. The test phase consisted of implanting a quadripolar electrode for DRG stimulation through puncture lateral to the buccal rim in a fluoroscopic coaxial view. The electrode was fixed to the skin and maintained for five days, during which the patient remained completely pain-free. After the test, the definitive implant was performed, now with intraoral puncture and maxillary electrode fixation. The patient presented with severe pain (verbal numerical scale between 9 and 10), manifesting an evident suicidal ideation. After a five-day test period, the definitive stimulation electrode was implanted through intraoral puncture. The patient remains pain-free in the three-month follow-up to the present, with no displacement of the electrode. The dorsal root ganglion electrode may be considered a therapeutic option in patients with severe trigeminal neuralgia. Controlled studies must be performed in order to determine the efficacy and safety of the method.