292 Spinal Cord Stimulation for the Atypical Facial Pain Syndrome Treatment

INTRODUCTION: Atypical facial pain remain challenging to manage primarily due to the extensive history of previous surgeries in affected patients. Traditional methods often lead to prolonged ataxia and undesirable side effects. Neuromodulatory techniques offer promising alternatives, emphasizing reversibility and the ability to conduct trial lead placements before permanent implantation. Among these, spinal cord stimulation (SCS) has gained attention. We explore its application specifically to the trigeminal tract and nucleus caudalis. METHODS: We reviewed 22 patients with refractory facial pain who underwent nucleus caudalis stimulation. Outcomes following the trial period (mean 23.5 days) and permanent stimulation were analyzed. 81% of patients had successful trial stimulation and received permanent implantation of the stimulation system in ante- or retrograde fashion. In the anterograde method, electrodes traverse under the C1 arch and through laminotomies in C2, terminating proximally near the foramen magnum. In the retrograde approach, they pass from the occpiput under both vertebral arches, terminating caudal to C2. RESULTS: The mean follow-up was 38.4 months (range: 6-60 months). Permanent implantation demonstrated a significant reduction in facial pain (mean VAS change from 8.8 to 3.5). Four (23.5%) patients demanded successful system revision, 75% of which were due to technical issues and one due to electrode displacement. The long-term treatment failure rate was 23.5%. One patient developed an epidural hematoma. Fisher’s exact test (p = 0.93) showed no significant association between the direction of lead placement and pain outcomes. CONCLUSIONS: Burst SCS effectively reduces atypical trigeminal neuropathic pain, thereby contributing to the decision-making process to alleviate neurological deficits compared to conventional procedures.