Fu F, Jiang XF, Wang JJ, Gong L, Yun C, Sun HT, Tang FW. Interpeduncular cistern intrathecal targeted drug delivery for intractable postherpetic neuralgia: A case report. World J Clin Cases 2023; 11(30): 7380-7385 [PMID: 37969450 DOI: 10.12998/wjcc.v11.i30.7380]
Corresponding Author of This Article
Feng-Wu Tang, MD, PhD, Chief Doctor, Departments of Pain Medicine, Characteristic Medical Center of People’s Armed Police, No. 220 Chenglin Road Dongli District, Tianjin 300162, China. doctang@126.com
Research Domain of This Article
Neurosciences
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Feng Fu, Xian-Feng Jiang, Lei Gong, Chen Yun, Feng-Wu Tang, Departments of Pain Medicine, Characteristic Medical Center of People’s Armed Police Forces, Tianjin 300162, China
Jing-Jing Wang, Tianjin Key Laboratory of Neurotrauma Repair, Institute of Neurotrauma Repair, Characteristic Medical Center of People’s Armed Police Forces, Tianjin 300162, China
Hong-Tao Sun, Department of Neurotrauma Repair, Characteristic Medical Center of People’s Armed Police Forces, Tianjin 300162, China
Author contributions: Fu F, Jiang XF and Tang FW contributed to design of the work; Fu F and Gong L contributed to data collection and analysis; Fu F, Yun C, Tang FW, and Wang JJ contributed to interpretation of data; Fu F, Jiang XF, Yun C, Sun HT, and Tang FW contributed to drafting and revision of the manuscript; All authors approved the final version of the manuscript.
Supported byNational Natural Science Foundation of China, No. 81891004; Tianjin Natural Science Foundation of China, No. 21JCQNJC01140.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Feng-Wu Tang, MD, PhD, Chief Doctor, Departments of Pain Medicine, Characteristic Medical Center of People’s Armed Police, No. 220 Chenglin Road Dongli District, Tianjin 300162, China. doctang@126.com
Received: July 1, 2023 Peer-review started: July 1, 2023 First decision: August 16, 2023 Revised: September 2, 2023 Accepted: September 28, 2023 Article in press: September 28, 2023 Published online: October 26, 2023 Processing time: 115 Days and 21.1 Hours
Abstract
BACKGROUND
Intractable postherpetic neuralgia (PHN) can be difficult to manage even with aggressive multimodal therapies. Patients who experience uncontrolled refractory cranial PHN despite conservative treatment may benefit from an intrathecal drug delivery system (IDDS). For craniofacial neuropathic pain, the traditional approach has been to place the intrathecal catheter tip below the level of the cranial nerve root entry zones, which may lead to insufficient analgesia.
CASE SUMMARY
We describe a 69-year-old man with a 1-year history of PHN after developing a vesicular rash in the ophthalmic division of cranial nerve V (trigeminal nerve) distribution. The pain was rated 7-8 at rest and 9-10 at breakthrough pain (BTP) on a numeric rating scale. Despite receiving aggressive multimodal therapies including large doses of oral analgesics (gabapentin 150 mg q12 h, oxycodone 5 mg/acetaminophen 325 mg q6 h, and lidocaine 5% patch 700 mg q12 h) and sphenopalatine ganglion block, there was no relief of pain. Subsequently, the patient elected to have an implantable IDDS with the catheter tip placed at the interpeduncular cistern. The frequency of BTP episodes decreased. The patient’s continuous daily dose was adjusted to 0.032 mg/d after 3 mo of follow-up and stopped 5 mo later. He did not report pain or other discomfort at outpatient follow-up 6 mo and 1 year after stopping intracisternal hydromorphone.
CONCLUSION
The use of interpeduncular cistern intrathecal infusion with low-dose hydromorphone by IDDS may be effective for severe craniofacial PHN.
Core Tip: We describe a case of refractory postherpetic neuralgia in the trigeminal nerve area that was successfully treated by implanting of an intrathecal drug delivery system with catheter tip placement at the interpeduncular cistern. We discuss the key points and difficulties in the surgical process and the future expansion of this technique.
