Percutaneous Trigeminal Neuromodulation for Refractory Facial Pain: A Single-Institution Case Series with Long-Term Follow-up.

BACKGROUND: Trigeminal neuralgia (TN) and persistent idiopathic facial pain (PIFP) are chronic facial pain syndromes that can be resistant to conventional medical and surgical treatments. Percutaneous trigeminal nerve and ganglion stimulation has emerged as a promising neuromodulation technique, though long-term safety and durability remain concerns. CASE REPORT: We conducted a retrospective review of patients with refractory TN or PIFP who underwent trial or permanent implantation of a trigeminal nerve stimulator between 2018 and 2024 at our institution. Ten of 11 patients underwent trial stimulation, with 9 proceeding to permanent implantation. At the most recent follow up, all but one patient reported significant pain relief. Device- or procedure-related complications occurred in 3 patients: one developed lead prominence with subsequent threatened anchor erosion requiring revision, one developed a postoperative methicillin-resistant staphylococcus aureus wound infection following device removal for urgent magnetic resonance imaging, and one experienced loss of V2 lead efficacy requiring lead explantation. An additional patient underwent elective device removal after long-term complete pain resolution. CONCLUSIONS: Percutaneous stimulation of the trigeminal nerve and ganglion appears to be a safe and effective treatment option for patients with refractory facial pain. The low complication rate and consistent pain relief support its use as a long-term management strategy. Prospective studies are needed to further validate these findings and guide patient selection.