Minimally invasive tubular retractor implantation of a paddle electrode stimulator for the trigeminal nucleus caudalis: illustrative case.

BACKGROUND: Paddle electrode stimulation of the trigeminal nucleus caudalis (TNC) for refractory craniofacial pain syndromes provides improved coverage and has lower migration rates than cylindrical leads; however, paddle implantation requires open surgery, which can cause significant pain and limit use in high-risk patients. Herein, the authors present a minimally invasive (MIS) approach, adapting the use of tubular retractors for MIS spine surgery and therefore minimizing the surgical morbidity of paddle electrode implantation at the craniocervical junction. OBSERVATIONS: An 81-year-old man with postherpetic trigeminal neuropathy in the left V1 and V2 distribution underwent paddle lead implantation via a 2.5-cm occipitocervical incision and a tubular retractor system. The patient experienced a reduction in pain (from a visual analog scale score of 9/10 to 2/10), without any postoperative complications. LESSONS: This technical report demonstrates the feasibility of implanting paddle electrodes via an MIS tubular retractor system for stimulating the TNC. The approach minimizes soft tissue disruption, reduces postoperative pain, and offers a viable alternative to open surgery, which is especially useful for medically complex patients requiring neuromodulation for craniofacial pain. https://thejns.org/doi/10.3171/CASE25721.