# Digital subtraction angiography-guided peripheral nerve stimulation via the foramen rotundum for refractory trigeminal postherpetic neuralgia: a case report and literature review

## TL;DR

A new method using digital subtraction angiography-guided nerve stimulation helped treat severe facial pain from a viral infection in a patient who had not responded to other treatments.

## Contribution

A novel DSA-guided peripheral nerve stimulation technique via the foramen rotundum for refractory trigeminal postherpetic neuralgia is introduced.

## Key findings

- The patient experienced disappearance of tactile allodynia after the procedure.
- Significant reduction in oral analgesic requirements was observed.
- No complications or side effects were noted during a 3-year follow-up.

## Abstract

Postherpetic neuralgia (PHN) is a debilitating complication of varicella-zoster virus infection. This case report presents a novel approach to treating refractory trigeminal maxillary postherpetic neuralgia using digital subtraction angiography (DSA)-guided peripheral nerve stimulation via the foramen rotundum. A 72-year-old female with severe, treatment-resistant pain underwent this intervention. The results demonstrated the disappearance of tactile allodynia, a significant reduction in oral analgesic requirements, and no observed complications or side effects during a 3-year follow-up period. This case highlights the potential effectiveness of DSA-guided peripheral nerve stimulation using a new dorsal root ganglion (DRG) stimulator as an alternative therapy for refractory trigeminal postherpetic neuralgia (TPHN).