Motor cortex stimulation in a three-year-old child with trigeminal neuropathic pain caused by a malignant glioma in the cerebellopontine angle: case report

Abstract

Background and importance: Motor cortex stimulation (MCS) is an accepted treatment in neuropathic pain syndromes. Use of MCS for trigeminal neuropathic pain (TNP) caused by a malignant glioma or in a child has not previously been reported in the literature.

Clinical presentation: A 3-year-old boy presented to our department with a right temporal tumor with extension into the cavernous sinus and along the root of the trigeminal nerve up to the protuberance. Six weeks after removal of the temporal part of the tumor, the patient developed medically refractory trigeminal pain associated with tumor progression into the posterior fossa. We decided to remove the tumor from the cerebellopontine angle and residual tumor in the pericavernous area and then gave postoperative radio- and chemotherapy. Five months later, the patient developed unbearable refractory neuropathic pain characterized by a burning sensation in the first and second trigeminal areas. After a multidisciplinary discussion, MCS was recommended. We performed subdural MCS after localization of the central sulcus via anatomic landmarks, neuronavigation, peroperative sensory evoked potentials, and motor evoked potentials. The mother estimated a 75% reduction in the child's pain at 48 hours postoperatively, which continued until the child was pain-free.

Conclusion: MCS is a minimally invasive surgical technique that seems to be a potential treatment for carefully selected children experiencing very severe and medically refractory neuropathic pain, even in the context of a neoplasm.