Name: subcutaneous trigeminal nerve field stimulation for refractory facial pain
Uploaded: 2017-05-10T13:00:00
Description: Watch this Scientific Journal Video about Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain at JoVE.com

这项工作得到DFG（Deutsche Forschungsgemeinschaft）资助的合作研究中心1158（SFB1158 From nociception to chronic pain：Structure-Function properties of neural pathways and their reorganization）的部分支持。

注意：所有程序都是作为单独的治疗尝试（“Individualueller Heilversuch”）执行的。并遵守当地的伦理委员会（Ethikkommission Heidelberg）以及关于个人治疗尝试的国家法律。患者被治疗医师广泛告知治疗的性质，程序，风险和益处。在开始手术之前，所有患者都提供书面知情同意书。个人治疗尝试需要得到患者医疗保健服务的报销。这必须由治疗医师在安排程序之前获得。 适应症...

<ol>
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通过皮下三叉神经域刺激（sTNFS），我们提出了一种手术技术，用于对不同病因的三叉神经的慢性难治性疼痛进行微创神经调节。 减少并发症彻底消毒整个手术领域至关重要。任何不必要的皮肤穿孔可能会随着系统的连续损失而增加设备感染的风险。医生应始终注意电极的植入深度，因为当植入距离皮肤表面0.5厘米以下时，它们会侵蚀皮肤。使用固定装置固定电极应彻底执行...

用于治疗三叉神经痛的神经外科手术与潜在病因相同大小多样。在三叉神经微血管减压（MVD） 1脑干根进入区动脉压缩造成的经典三叉神经痛（TN）的情况下，高度有效。 加速器神经节的经皮破坏性技术（如射频热凝，甘油注射或气囊压缩2 ）和三叉神经痛立体定向放射外科手术可应用于无神经血管疾病或无明显外科手术禁忌症的情况。然而，所有技术都与某些疼痛复发率相关。此外，治疗本身具有导致神经性疼痛或甚至疼痛的创伤后三叉神经病变的神经损伤的风险。最后，三叉神经痛来源于中心（例如脑卒中后疼痛）将不会对Gasser神经节的MVD或破坏性技术作出反应，但需要通过神经调节治疗，如深部脑刺激（DBS）或运动皮层刺激（MCS）。 神经调节是用于外科技术的术语，其似乎改变神经活动而不引起不可逆的组织损伤。神经调节治疗是可逆的，适应性的，通常可以间断或连续地将电流施加到外周或中枢神经系统的部分。有几种认证（CE和/或FDA批准）治疗可用于治疗躯干和四肢的慢性和/或神经性疼痛，如硬膜外脊髓刺激（SCS），周围神经区域刺激（PNFS）或背根神经节刺激（DRG） 4 。然而，目前没有CE或FDA批准的治疗可用于慢性神经性面部和三叉神经痛/ P&gt; 针对不同来源的慢性面部疼痛患者，深部脑刺激（DBS）和运动皮层刺激（MCS）已被应用于多种病例系列。然而，这两种技术都具有高度的复杂性，并且需要特殊的医师专长。当保守治疗失败并且需要避免破坏性技术时，需要简单，成本效益和有效的慢性三叉神经和面部疼痛的神经调节。 除外科手术外，一系列非侵入性或临时形式的神经调节可用于治疗慢性疼痛（ 例如 PENS：经皮电神经刺激，TENS：经皮电神经刺激，TMS：经颅磁刺激）。 皮下周围神经域刺激（sPNFS）是神经调节的最小侵入形式。一个或多个电极a重新置于疼痛区域的皮下组织中。应用持续的电刺激来产生令人愉悦的感觉异常，涵盖痛苦的区域。确切的行动机制是未知的。然而，尽管存在所有缺点，但类似的机制，如门控制理论，或其变化，假设抑制性纤维的伤害性输入的调制是最常用的。另外，讨论了周围神经纤维的局部去极化阻滞，其兴奋性降低以及关于炎性蛋白质的微环境变化。 如在大多数神经调节程序中，执行连接到脉冲发生器的外部电极的测试试验以评估在完全植入式脉冲发生器（IPG）被放置在皮下组织中并连接到电极之前的有效性，作为用于刺激的电源治疗情况CCESS。没有一个积极的测试试验的一般定义，但在视觉模拟量表（VAS）上减少50％或更多的疼痛通常被认为是标志性标准。此外，减少口服止痛药物或提高生活质量可能是有利于植入永久性系统的因素。 外周神经域刺激被认证用于慢性腰痛8 ，并已被用于局部慢性疼痛综合征（ 例如 ，发作后疼痛）。它也用作枕骨神经刺激（ONS）治疗慢性偏头痛和丛集性头痛9 。几项非随机研究表明，三叉神经根皮瘤中sPNFS用于不同来源的慢性和神经性难治性疼痛（经典TN，非典型TN，疱疹后三叉神经病，MS相关性三叉神经病，持续性特发性面部疼痛） 10 </sup&gt; ， 11，12 。 皮下三叉神经区域刺激（sTNFS）容易且快速。与DBS或MCS相反，sTNFS可以作为门诊手术（如果报销）执行。没有颅内或硬膜外出血的风险。癫痫发作不发生。试验刺激是在动态的环境下进行的，以便病人能够在执行他的日常生活中评估刺激效果，而不是绑在医院病床上。无需广泛的术前或术前成像来确定电极的正确位置。在考虑神经病理或中枢性疼痛患者的MCS或DBS之前，sTNFS可以被认为是在应用经皮破坏性手术或作为较少侵入性类型的神经调节之前调节疼痛感知和加工的治疗选择。

<table border="0" cellpadding="0" cellspacing="0" width="1257">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">myStim Patient Programmer</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">97740</td>
			<td style="width:709px;">enables the patient to turn off and on stimulation</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Prime Advanced</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">97702</td>
			<td>non-rechargeable IPG as powersource for stimulation</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Restore Ultra</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">97712</td>
			<td>rechargeable IPG as powersource for stimulation</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Charging System</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">97754</td>
			<td>used by the patient to recharge the Restore Ultra IPG</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">N&#39;Vision Programmer</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">8840</td>
			<td>used by the physician to program the IPG and define stimulation parameters</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">External Neurostimulator</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">37022</td>
			<td>external IPG as powersource for trial stimulation with externalized electrodes</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Advanced Screening Cable</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">355531</td>
			<td>connects externalized electrodes to the external neurostimulator during trial stimulation</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Tunnelling Spear 60cm</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">3655-60</td>
			<td>used to subcutaneously tunnel the permanent electrodes to an infraclavicular pocket that houses the IPG</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Tunnelling Spear 38cm</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">3655-38</td>
			<td>used to subcutaneously tunnel the permanent electrodes to an infraclavicular pocket that houses the IPG</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Tuhoy Cannula</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">3550-32</td>
			<td>14 gauge Epidural Tuhoy cannula (length 9cm) to subcutaneously implant the electrodes</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">InjexFixation Device</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">97791 / 97792</td>
			<td>used to fixate the electrodes on the skin or on the muscle fascia</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Octad Compact</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">3878-60</td>
			<td>permanent electrode (length 60cm) implanted in the subcutaneous tissue with 8 contacts</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Vectris Trial Lead</td>
			<td style="width:213px;">Medtronic</td>
			<td style="width:119px;">977D260</td>
			<td>externalized electrode (length 60cm) used during the stimulation trial</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Ethilon*II 3-0</td>
			<td style="width:213px;">Ethicon</td>
			<td style="width:119px;">EH7933H</td>
			<td>non-absorbable suture for skin closure</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Seide 2-0</td>
			<td style="width:213px;">Resorba</td>
			<td style="width:119px;">40221</td>
			<td>non-absorbable silk suture to fixate electrodes and IPG</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Resolon DS21</td>
			<td style="width:213px;">Resorba</td>
			<td style="width:119px;">881413</td>
			<td>absorbable suture for subcutaneous wound closure</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Feather disposable scalpel</td>
			<td style="width:213px;">Feather</td>
			<td style="width:119px;">5205052</td>
			<td>single use scalpel for skin incision and suture cutting</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Scandicain 1%</td>
			<td style="width:213px;">Astra Zeneca</td>
			<td style="width:119px;">23186</td>
			<td>1% Mepivacain solution for local anesthesia</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Cosmopor E steril 10x6</td>
			<td style="width:213px;">Hartmann</td>
			<td style="width:119px;">900871</td>
			<td>Sterile draping for IPG wound</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Cosmopor E steril 7,2x5</td>
			<td style="width:213px;">Hartmann</td>
			<td style="width:119px;">900870</td>
			<td>Sterile draping for skin punctures and small incisions</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Foliodrape Comfort 50x50</td>
			<td style="width:213px;">Hartmann</td>
			<td style="width:119px;">252302</td>
			<td>Sterile draping for the surgical field</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Cephazolin</td>
			<td style="width:213px;">Fresenius</td>
			<td style="width:119px;">6062403.00.00</td>
			<td>Single shot perioperative antibiotic</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Kepinol forte 800mg/160mg</td>
			<td style="width:213px;">Dr. R. Pfleger Chemische Fabrik</td>
			<td style="width:119px;">2485177</td>
			<td>Postoperative prophylactic oral antibiotic</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Poly-Alcohol</td>
			<td style="width:213px;">Antiseptica</td>
			<td style="width:119px;">UN1219</td>
			<td>Coloured skin disinfectant used during the permanent implantation</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Cutasept F</td>
			<td style="width:213px;">Bode</td>
			<td style="width:119px;">976800</td>
			<td>Un-Coloured skin disinfectant used during the trial implantation</td>
		</tr>
	</tbody>
</table>

subcutaneous trigeminal nerve field stimulation for refractory facial pain

慢性或神经性三叉神经面痛可能是具有挑战性的治疗。当保守治疗失败时，应适用神经外科手术。慢性面部疼痛的神经调节技术包括深层脑刺激和运动皮层刺激，这些复杂的表现。皮下神经域刺激被认证为慢性背痛，是神经调节的最小侵入形式。我们应用这种技术治疗慢性和神经性三叉神经痛作为个体治疗概念。首先，进行试验刺激。在局部麻醉下将皮下引线置于疼痛的三叉神经皮肤。引线连接到应用恒定刺激的外部神经刺激器。患者接受12天门诊试验以评估刺激的效果。试验后电极被去除。如果患者报告疼痛减轻至少50％的强度和/或攻击频率，则减少用药或提高生活质量，定期进行永久植入。在全身麻醉下植入新电极，并皮下隧道穿入锁骨内部脉冲发生器。患者能够根据需要打开和关闭刺激并增加或减少刺激幅度。 这种技术代表了三叉神经痛的其他更具侵入性的神经调节手段，如运动皮层刺激或深部脑刺激的最小侵入性替代方法。

<html>由于皮下三叉神经域刺激（sTNFS）不是标准治疗，与其他疾病相比，潜在受益的患者数量相当小，所以只有较小的病例系列表现出sTNFS的结果。在一个系列中，10例患者接受了sTNFS的检测刺激。八名患者对治疗作出反应，并接受电极和IPG 11的永久植入。患者患有三叉神经痛，与多发性硬化有关的三叉神经病变，疱疹后三叉神经病，放射性三叉神经病和?...

Watch this Scientific Journal Video about Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain at JoVE.com

Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain

当医疗或标准治疗失败时，治疗慢性或神经性面部疼痛可能具有挑战性。皮下神经域刺激是神经调节的最小侵入形式，用于慢性背痛。我们应用这项技术治疗慢性和神经性三叉神经面部疼痛。

皮下三叉神经场刺激难治性面部疼痛

Chronic or neuropathic trigeminal facial pain can be challenging to treat. Neurosurgical procedures should be applied when conservative treatment fails. ...

Research

JoVE Journal

Medicine

Chronic Constriction of the Sciatic Nerve and Pain Hypersensitivity Testing in Rats

慢性缩窄大鼠坐骨神经疼痛过敏测试

Chronic neuropathic pain, resulting from damage to the central or peripheral nervous system, is a prevalent and debilitating condition, affecting 7-18% of ...

科研

医学

Breathing-controlled Electrical Stimulation (BreEStim) for Management of Neuropathic Pain and Spasticity

Breathing-controlled Electrical Stimulation BreEStim for Management of Neuropathic Pain and Spasticity

呼吸控制电气的刺激（BreEStim）的神经性疼痛和痉挛的管理

Electrical stimulation (EStim) refers to the application of electrical current to muscles or nerves in order to achieve functional and therapeutic goals. ...

The Sciatic Nerve Cuffing Model of Neuropathic Pain in Mice

神经病理性疼痛小鼠坐骨神经掴型号

Neuropathic pain arises as a consequence of a lesion or a disease affecting the somatosensory system. This syndrome results from maladaptive changes in ...

Facial Nerve Axotomy in Mice: A Model to Study Motoneuron Response to Injury

面神经干切断小鼠：模型，研究运动神经元损伤反应

The goal of this surgical protocol is to expose the facial nerve, which innervates the facial musculature, at its exit from the stylomastoid foramen and ...

Chronic Constriction Injury of the Rat's Infraorbital Nerve (IoN-CCI) to Study Trigeminal Neuropathic Pain

Chronic Constriction Injury of the Rat's Infraorbital Nerve IoN-CCI to Study Trigeminal Neuropathic Pain

老鼠的眶下神经（ION-CCI）研究三叉神经性疼痛性损伤

Animal models are important tools to study the pathophysiology and pharmacology of neuropathic pain. This manuscript describes the surgical and behavioral ...

The Monoiodoacetate Model of Osteoarthritis Pain in the Mouse

骨关节炎疼痛的鼠标Monoiodoacetate模式

A major symptom of patients with osteoarthritis (OA) is pain that&#160;is triggered by peripheral as well as central changes within the pain pathways. The ...

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor

MRI 引导下聚焦超声丘脑治疗难治性原发性震颤

Essential tremor (ET) is the most common type of tremor in adults. While ET does not result in decreased life expectancy, the disabilities associated with ...

Cavernous Nerve Stimulation and Recording of Intracavernous Pressure in a Rat

大鼠海绵状神经刺激与海绵压力记录

The stimulation of the cavernous nerve (CN) and measurement of intracavernous pressure (ICP) have been used extensively to test and evaluate therapies for ...

Vagus Nerve Stimulation As an Adjunctive Neurostimulation Tool in Treatment-resistant Depression

迷走神经刺激作为抗抑郁抑郁症的辅助神经刺激工具

Vagus nerve stimulation (VNS) is an approved neurostimulation therapy. The purpose of the method is to treat patients with therapy-resistant depression ...