Effective treatment of refractory complex facial pain with motor cortex stimulation by spinal paddle electrodes using multimodal imaging

Abstract Background Complex facial pain is a debilitating condition with varying etiologies that overall responds poorly to both medical and traditional surgical management. Cortical stimulation unique therapeutic intervention which can be effective for some types of complex syndromes (CFPS). However, the novel use preoperative functional magnetic resonance imaging (fMRI) diffusion tensor (DTI) coupled intraoperative mapping phase reversal improve accuracy placement spinal paddle electrodes in motor cortex stimulation, our knowledge, has not been reported literature. Case presentation Here, we present case 56-year-old male who developed left-sided syndrome after stroke refractory management peripheral nerve stimulation. He previously underwent microvascular decompression (MVD) limited control his pain. In order treat this, patient The strip face tongue was identified preoperatively (DTI). Intraoperatively, used identify corticospinal tracts stimulus confirmed location before epidural two electrodes. Postoperatively, significant reduction levels, burning dysesthesias, intensity frequency symptoms. This trend continued, experienced equivalent levels relief at 6 months. Conclusions rare report successful fMRI DTI, mapping, successfully guide treatment CFPS.