Progress in Neurological Surgery Editor: L.D. Lunsford Vol. 35 Neuromodulation for Facial Pain Editor K.V.Slavin Neuromodulation for Facial Pain Progress in Neurological Surgery Vol. 35 Series Editor L. Dade Lunsford Pittsburgh, PA Neuromodulation for Facial Pain Volume Editor Konstantin V. Slavin Chicago, IL 52 figures, 30 in color, and 18 tables, 2020 Basel · Freiburg · Hartford · Oxford · Bangkok · Dubai · Kuala Lumpur · Melbourne · Mexico City · Moscow · New Delhi · Paris · Shanghai · Tokyo Konstantin V. Slavin Section of Stereotactic and Functional Neurosurgery University of Illinois College of Medicine Chicago, IL (USA) Library of Congress Cataloging-in-Publication Data Names: Slavin, Konstantin V., editor. Title: Neuromodulation for facial pain / volume editor, Konstantin V. Slavin. Other titles: Progress in neurological surgery ; v. 35. 0079-6492 Description: Basel ; Hartford : Karger, 2020. | Series: Progress in neurological surgery, 0079-6492 ; vol. 35 | Includes bibliographical references and index. | Summary: “This book presents a collection of chapters on all kinds of neuromodulation approaches used today in the management of facial pain, providing a comprehensive review of the entire field in a systematic manner”-- Provided by publisher. Identifiers: LCCN 2020031785 (print) | LCCN 2020031786 (ebook) | ISBN 9783318067941 (hardcover) alk. paper | ISBN 9783318067958 (ebook) Subjects: MESH: Facial Neuralgia--therapy | Transcutaneous Electric Nerve Stimulation Classification: LCC RC936 (print) | LCC RC936 (ebook) | NLM W1 PR673 v.35 2020 | DDC 617.5/2--dc23 LC record available at https://lccn.loc.gov/2020031785 LC ebook record available at https://lccn.loc.gov/2020031786 Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents® and MEDLINE/Pubmed. Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. © Copyright 2020 by S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland) www.karger.com Printed on acid-free and non-aging paper (ISO 9706) ISSN 0079–6492 eISSN 1662–3924 ISBN 978–3–318–06794–1 e-ISBN 978–3–318–06795–8 Contents VII Preface Slavin, K.V. (Chicago, IL) 1 Classification of Facial Pain: A Clinician’s Perspective Hupe, C.G.; Slavin, K.V. (Chicago, IL) 18 Anatomy of Trigeminal Neuromodulation Targets: From Periphery to the Brain Goellner, E. (Porto Alegre); Rocha, C.E. (São Paulo) 35 Transcutaneous Electrical Nerve Stimulation for Facial Pain Zayan, K.; Felix, E.R.; Galor, A. (Miami, FL) 45 Percutaneous Electrical Nerve Stimulation for Facial Pain Vajramani, G. (Southampton) 60 Peripheral Nerve Stimulation for Facial Pain Using Conventional Devices: Indications and Results Winfree, C.J. (New York, NY) 68 Peripheral Nerve Stimulation for Facial Pain Using Conventional Devices: Technique and Complication Avoidance Mogilner, A.Y. (New York, NY) 75 Peripheral Nerve Stimulation for Facial Pain Using Wireless Devices Stokey, B.G. (Cleveland, OH); Weiner, R.L. (Dallas, TX); Slavin, K.V. (Chicago, IL); Hayek, S.M. (Cleveland, OH) 85 High-Frequency Peripheral Nerve Stimulation for Craniofacial Pain Finch, P.; Drummond, P. (Perth, WAU) 96 Gasserian Ganglion Stimulation for Facial Pain Yin, D. (Flint, MI); Slavin, K.V. (Chicago, IL) 105 Sphenopalatine Ganglion Stimulation for Chronic Headache Syndromes Vesper, J.; Santos Piedade, G.; Hoyer, R.; Slotty, P.J. (Düsseldorf) 116 Transcranial Direct Current Stimulation in the Treatment of Facial Pain Antal, A. (Göttingen) 125 Transcranial Neurostimulation (rTMS, tDCS) in the Treatment of Chronic Orofacial Pain Fricová, J.; Rokyta, R. (Prague) 133 Cervical Spinal Cord Stimulation for Facial Pain Jones, M.R.; Baskaran, A.B.; Rosenow, J.M. (Chicago, IL) V 141 Deep Brain Stimulation for Facial Pain Singleton, W.G.B.; Ashida, R.; Patel, N.K. (Bristol) 162 Motor Cortex Stimulation for Facial Pain Teton, Z.E.; Raslan, A.M. (Portland, OR) 170 Neurosurgical Management of Cancer Facial Pain Mirzadeh, Z.; Sheehy, J.P. (Phoenix, AZ); Ben-Haim, S. (La Jolla, CA); Rosenberg, W.S. (Kansas City, MO) 181 Targeted Drug Delivery (Intrathecal and Intracranial) for Treatment of Facial Pain Dupoiron, D. (Angers) 194 Author Index 195 Subject Index VI Contents Preface Published online: July 22, 2020 Slavin KV (ed): Neuromodulation for Facial Pain. Prog Neurol Surg. Basel, Karger, 2020, vol 35, pp VII–VIII (DOI: 10.1159/000509487) Preface Konstantin V. Slavin Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA Perhaps the most unique and just as important part of the human anatomy, the face rep- resents less than 5% of the body surface area in an adult and its sensation is primarily sup- plied by a single cranial nerve on each side, the trigeminal nerve, with only minor contri- butions from multiple secondary nerves. In the central nervous system, however, the face is represented in a rather complex and disproportionally large manner, and this complex- ity correlates with the high prevalence, major psychological impact, and great diversity of various pain syndromes that involve face and facial structures. Along with many clinical conditions that present with facial pain and a multitude of relevant pain types, there are different treatment approaches including variety of inter- ventional modalities and surgical procedures that are aimed at the extracranial and intra- cranial components of the trigeminal system. These interventions and surgeries are not chosen arbitrarily, but are based on very specific indications, and the escalating degree of invasiveness dictates the sequence in which these approaches are chosen. As a matter of fact, in our routine neurosurgical practice we tend to follow a certain algorithm that fa- cilitates the choice of appropriate procedure based on a straightforward set of clinical fea- tures [1]. In a field of pain surgery, as in most areas of functional neurosurgery, the interventions are divided into decompression, ablation and modulation, and when decompression is not an option or if it fails, one has to choose between advantages and disadvantages of ei- ther precise and focused destruction or a nondestructive alternative of neuromodulation. Recently, neuromodulation has become more of a mainstream of pain surgery; as the mat- ter of fact, it in essence replaced most neuroablative interventions. This trend toward pre- ferred use of neuromodulation is, indeed, reaching the way we approach management of facial pain, and the long list of available neuromodulatory interventions is getting longer, targeting every component of the trigeminal nociceptive system. For most of us, in and out of neurosurgical community, facial pain does not come to mind as a main indication for neuromodulation – as the matter of fact, the vast majority of neuromodulation interventions are done for patients with pain in the lower back and the extremities. The deep brain stimulation is used mainly for treatment of movement disorders, and cranial nerve stimulation – for epilepsy and depression. However, if one looks at the history of neuromodulation, facial pain was by far the first indication for im- planted electrical stimulators when Shelden et al. [2] in 1962 operated on 3 patients with facial pain and placed silicone electrodes around their trigeminal branches even before the gate-control theory was published by Melzack and Wall in 1965 [3] and the first spinal cord stimulator was implanted by Shealy in 1967 [4]. Similarly, many years before stimu- lation of sensory ganglia became mainstream in the treatment of bodily pain, neurosur- geons were using Gasserian ganglion stimulation for the treatment of facial pain in late 1970s [5]. And the list goes on. This book presents a collection of chapters on all kinds of neuromodulation approach- es used today in the management of facial pain in an attempt to provide a comprehensive review of the entire field in a systematic manner. For neuromodulation practitioners and all other specialists who treat facial pain it may be interesting to learn about advances in facial pain classification, use of noninvasive neuromodulation, early experience with in- novative technology used for neuromodulation, as well as technical aspects, patient selec- tion, and complication management for specific applications of electrical and chemical neuromodulation that are currently available for clinical use. The volume follows the long tradition of the Karger’s series Progress in Neurological Surgery to focus on the cutting edge of neurosurgical research and innovation. References 1 Slavin KV, Nersesyan H, Colpan ME, Munawar N: Cur- 4 Shealy CN, Mortimer JT, Reswick JB: Electrical inhibi- rent algorithm for the surgical treatment of facial pain. tion of pain by stimulation of the dorsal columns. Pre- Head Face Med 2007;3:30. liminary clinical report. Anesth Analg 1967;46:489–491. 2 Shelden CH, Pudenz RH, Doyle J: Electrical control of 5 Myerson BA, Hakansson S: Alleviation of atypical tri- facial pain. Am J Surg 1967;114:209–212. geminal pain by stimulation of the Gasserian ganglion 3 Melzack R, Wall PD: Pain mechanisms: a new theory. via an implanted electrode. Acta Neurochir Suppl Science 1965;150:971–979. (Wien) 1980;30:303–309. Konstantin V. Slavin Department of Neurosurgery, University of Illinois at Chicago 912 S. Wood Street, M/C 799 Chicago, IL 60612 (USA) kslavin @ uic.edu VIII Slavin Slavin KV (ed): Neuromodulation for Facial Pain. Prog Neurol Surg. Basel, Karger, 2020, vol 35, pp VII–VIII (DOI: 10.1159/000509487) Published online: July 31, 2020 Slavin KV (ed): Neuromodulation for Facial Pain. Prog Neurol Surg. Basel, Karger, 2020, vol 35, pp 1–17 (DOI: 10.1159/000509652) Classification of Facial Pain: A Clinician’s Perspective Christy A. Gomez Hupe Konstantin V. Slavin Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA Abstract Successful management of facial pain starts with making correct diagnosis. Diagnostic errors, particu- larly early on in evaluation of facial pain patients are not uncommon, and some of this may be related to the lack of uniform classification that would satisfy needs of different specialists. Here, we critically review several most common classification schemes and try to compare and contrast their strength and unique features. We also attempt to link multiple terminologies describing same clinical conditions and provide a rationale for developing a unified nosological approach. Based on our findings, we conclude that despite many previous attempts, much work needs to be done to create a universally accepted, comprehensive but at the same time simple and user-friendly, facial pain classification, with the ultimate goal of integrating such classification into a treatment-guiding algorithm(s). © 2020 S. Karger AG, Basel Introduction Neuromodulation can be an excellent choice for the treatment of facial pain, but a precise formulation of correct diagnosis is critical to positive outcomes. Facial pain, as is widely quoted, may affect up to 26% [1] of the population and is frequently severe and debilitat- ing. The general term “facial pain” encompasses a wide range of conditions and, although presentations may be similar, the nuances indicate significant variations which will be more or less responsive to different management strategies – neuromodulation in par- ticular. Familiarity with classification systems for facial pain helps the clinician in careful