Deep Brain Stimulation of the Ventroposteromedial (VPM) Thalamus 10 Years after VPM Thalamotomy to Treat a Recurrent Facial Pain
Stereotactic and Functional Neurosurgery
Introduction After it was first reported by Hécaen et al.  and Monnier and Fischer  in 1949 and 1951, respectively, ventroposteromedial (VPM) or ventroposterolateral thalamotomy was commonly proposed to treat neuropathic pain [3, 4] . Starting in the 1980s     , ablative procedures were progressively replaced by deep brain stimulation (DBS) of the same structures, with the advantage of being reversible treatments. Nevertheless, the combination of thalamotomy followed by
... in facial pain management has, to the best of our knowledge, never been reported in the literature. We present a patient who had long-lasting but temporary facial pain relief after VPM thalamotomy, in whom DBS in the vicinity of the previous lesion was performed to provide further pain relief following the recurrence of identical burning right-sided facial neuralgia. Case Report A 62-year-old woman who suffered from an atypical V1-V2 right-sided neuralgia was successfully treated a decade ago with a radiofrequency lesion of the VPM. Ten years after a left VPM thal- Abstract We report the successful treatment of recurrent facial pain by deep brain stimulation (DBS) of the ventroposteromedial thalamic nucleus (VPM-DBS), 10 years after VPM thalamotomy. A 62-year-old woman who suffered from an atypical right-sided trigeminal neuralgia of the V1 and V2 branches was successfully treated a decade ago with a radiofrequency VPM thermocoagulation. Ten years later, the same burning right-sided trigeminal pain progressively recurred and was resistant to medical treatments. A DBS procedure was proposed to the patient aiming to stimulate the vicinity of the preexisting stereotactic lesion. Intraoperatively, the pain relief was immediate at low stimulation intensities. Eleven months later, the patient remains pain free. This case report suggests that DBS targeting an area of the VPM close to the previous stereotactic lesion is possible as a salvage therapy, and can successfully achieve relief of facial pain 10 years after VPM thalamotomy.