الفهرس 
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Abstract
Surgical options for treatment of medically intractable neuropathic facial pain: an outcome assessment study.
Hisham A. Simry, Ahmad E. Abdelbar, Hatem A. Sabry, Ahmed M. Raslan, Ahmed Kamel Basha
Department of Neurosurgery, Faculty of Medicine, Ain Shams University
Corresponding author: Ahmed Kamel Basha; Mobile: 01007609212; Email: ahmedbasha@med.asu.edu.eg
Abstract
Background; Facial pain is a common condition with a worldwide prevalence of 10-25% in adults. It often us a serious condition that can have a significant impact on patients’ daily life activities. The three main categories of facial pain are trigeminal neuralgia, trigeminal neuropathic pain and persistent idiopathic facial pain. To date, trigeminal neuropathy remains a potentially surgical pathology for the purpose of pain control with poor response to medical treatment.
Aim and objectives; The aim of this study is to present our experience in the management of different pathologies of trigeminal neuropathy and to review the effectiveness and long-term efficacy of the different surgical procedures.
Subjects and methods; This is a mixed prospective-retrospective study conducted at Ain Shams University (ASU) hospital and Oregon Health and Science University (OHSU) during the period from December 2012 till July 2020 for the retrospective part and from January 2019 till September 2021 for the prospective part. Patients with neuropathic facial pain treated during this time frame were included in the study.
Result; 28 patients were included in this study. They underwent 40 surgical interventions for the management of different categories of trigeminal neuropathy. Neuro-modulatory procedures were performed in 9 patients (3 ucSCS and 6 PNS) while neuro-ablative procedures were performed in 19 patients. Median time to pain recurrence after SCS device implantation for the neuropathic trigeminal neuralgia was 19.5 months. For the patients treated with PNS, 2 out of 6 of patients had satisfactory pain relief, whereas half of the patients had no improvement. Overall median time to pain recurrence after CT guided T/N was 5.6 months. In the cohort of patients treated with caudalis DREZ, 4 patients out of 6 had grade I pain relief at last follow up and the overall median time to pain recurrence was 3.9 months.
Conclusion; Trigeminal neuropathy is a difficult to treat entity of facial pain syndromes. Although many neuro-modulatory and neuro-ablative interventions are available in the armamentarium for the treatment of such pathology, outcomes remain suboptimal. Pain relief in the immediate postoperative period is usually higher than at last follow up which is a common finding in after these interventions. The long-term efficacy of most available interventions does not meet patients’ satisfaction.
Keywords; Trigeminal neuropathy, neuro-ablative procedures, neuromodulation, CT guided trigeminal Tractotomy/ Nucleotomy