Long-term relief of refractory trigeminal neuropathy using high-frequency spinal cord stimulation at the cervicomedullary junction: a 6-year follow-up case report

TL;DR

A patient with severe facial pain found long-term relief through high-frequency spinal cord stimulation at a specific brainstem location.

Contribution

This case demonstrates the long-term efficacy of high-frequency spinal cord stimulation at the cervicomedullary junction for refractory trigeminal neuropathy.

Findings

Complete relief of paroxysmal electric shock-like pain was achieved with 10 kHz HFSCS targeting the cervicomedullary junction.

Analgesia was sustained for 6 years with only a transient relapse due to battery depletion.

Neurophysiological evidence showed reduced trigeminal nociceptive activity following the procedure.

Abstract

Chronic neuropathic pain profoundly impairs quality of life and often remains refractory to pharmacological or surgical management. Spinal cord stimulation (SCS) is considered a second-line therapy when conventional treatments fail. In this context, high-frequency spinal cord stimulation (HFSCS) targeting the cervicomedullary junction (CMJ) has emerged as a promising option for drug-refractory facial pain syndromes, including trigeminal neuropathy, though clinical evidence remains limited. We report the case of a 67-year-old woman who developed severe right-sided trigeminal neuropathic pain following petroclival meningioma surgery. After multiple unsuccessful interventions, she underwent implantation of a 10 kHz HFSCS system targeting the CMJ. An epidural lead was placed at the C1-C2 level and connected to an implantable pulse generator, delivering continuous stimulation. The procedure produced complete relief of paroxysmal electric shock-like pain and neurophysiological evidence of reduced trigeminal nociceptive activity. Analgesia was sustained for 6 years, with a transient relapse due to battery depletion, which resolved completely after generator replacement. These findings confirm the long-term efficacy and durability of CMJ-targeted HFSCS and highlight the importance of structured follow-up and device maintenance. HFSCS at the CMJ may represent a safe and durable therapeutic option for refractory trigeminal neuropathy, warranting validation through larger prospective studies.

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