# 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.

## Key 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.