Selective Percutaneous Controlled Radiofrequency Thermocoagulation of the Gasserian Ganglion To Control Facial Pain Due to Medication-Related Osteonecrosis of the Jaw

2017 ◽  
Vol 20 (10) ◽  
pp. 1171-1174 ◽  
Author(s):  
Ayano Taniguchi ◽  
Keita Fukazawa ◽  
Toyoshi Hosokawa
Keyword(s):  
Facial Pain ◽  
Osteonecrosis Of The Jaw ◽  
Gasserian Ganglion ◽  
Radiofrequency Thermocoagulation

scholarly journals Radiofrequency Thermocoagulation Through Foramen Rotundum Versus Foramen Ovale for the Treatment of V2 Trigeminal Neuralgia

2019 ◽  
Vol 6 (22;6) ◽  
pp. E609-E614
Author(s):  
Cong-yang Yan
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Operation Time ◽  
Controlled Clinical Trial ◽  
Gasserian Ganglion ◽  
Internal Opening ◽  
Foramen Ovale ◽  
Maxillary Nerve ◽  
Radiofrequency Thermocoagulation ◽  
Foramen Rotundum

Background: Percutaneous radiofrequency thermocoagulation through the foramen rotundum (FR) is a new approach for the treatment of V2 trigeminal neuralgia (TN). Objectives: This study aimed to compare the efficacy and safety of the FR approach with that of the foramen ovale (FO) approach. Study Design: Nonrandomized controlled clinical trial. Setting: The study was conducted at Huaian Hospital of Huaian City, Huaian, China. Methods: From July 2014 to December 2016, 80 consecutive patients with V2 TN were prospectively assigned into the FO group (n = 40) or the FR group (n = 40). All radiofrequency thermocoagulation procedures were performed under the guidance of digital subtraction angiography (DSA). Patients in the FO group were treated with Gasserian ganglion ablation through the Hartel approach. Patients in the FR group received ablation of the maxillary nerve at the internal opening of the FR. Facial pain was evaluated using the Visual Analog Scale preoperatively and postoperatively at 1 week, 6 months, and 1 year. Results: All surgical procedures were successfully completed using DSA guidance. The FR group had no facial pain at postoperative 1 week, 6 months, and 1 year. The facial fain was not relieved in 4 patients of the FO group. They were treated with radiofrequency thermocoagulation of the maxillary nerve through the FR and maintained painless at postoperative 1 week, 6 months, and 1 year. At postoperative 1 year, another 3 patients relapsed in the FO group. The incidences of facial numbness and swelling did not differ significantly between the 2 groups (all P > 0.05). There was no postoperative corneal involvement or masticatory weakness in the FR group. However, corneal involvement and masticatory weakness occurred postoperatively in 22 (55%) patients and 31 (77.5%) patients in the FO group. The FR group had significantly shorter operation time than the FO group (19.3 ± 5.9 vs. 32.7 ± 8.7 minutes; P < 0.05). Limitations: We were unable to avoid the V1 and V3 branches, despite multiple adjustments of the needed position in 35 of the 40 patients in this group. Conclusions: For the treatment of V2 TN, thermocoagulation of the maxillary nerve through the FR had better efficacy and fewer complications in comparison with the Gasserian ganglion ablation through the FO

scholarly journals Percutaneous radiofrequency treatment of the gasserian ganglion for trigeminal neuralgia complicated by trochlear nerve palsy: a case report

2021 ◽  
pp. rapm-2020-102285
Author(s):  
Pascal SH Smulders ◽  
Michel AMB Terheggen ◽  
José W Geurts ◽  
Jan Willem Kallewaard
Keyword(s):  
Trigeminal Neuralgia ◽  
Cranial Nerve ◽  
Facial Pain ◽  
Anatomical Variations ◽  
Anterior Inferior Cerebellar Artery ◽  
Gasserian Ganglion ◽  
Radiofrequency Treatment ◽  
Experienced Pain ◽  
Cerebellar Artery ◽  
Trochlear Nerve Palsy

BackgroundTrigeminal neuralgia (TN) has the highest incidence of disorders causing facial pain. TN is provoked by benign stimuli, like shaving, leading to severe, short-lasting pain. Patients are initially treated using antiepileptic drugs; however, multiple invasive options are available when conservative treatment proves insufficient. Percutaneous radiofrequency treatment of the trigeminal, or gasserian, ganglion (RF-G) is a procedure regularly used in refractory patients with comorbidities. RF-G involves complex needle maneuvering to perform selective radiofrequency heat treatment of the affected divisions. We present a unique case of cranial nerve 4 (CN4) paralysis after RF-G.Case presentationA male patient in his 60s presented with sharp left-sided facial pain and was diagnosed with TN, attributed to the maxillary and mandibular divisions. MRI showed a vascular loop of the anterior inferior cerebellar artery without interference of the trigeminal complex. The patient opted for RF-G after inadequate conservative therapy. The procedure was performed by an experienced pain physician and guided by live fluoroscopy. The patient was discharged without problems but examined the following day for double vision. Postprocedural MRI showed enhanced signaling between the trigeminal complex and the brainstem. Palsy of CN4 was identified by a neurologist, and spontaneous recovery followed 5 months after the procedure.ConclusionsMention of postprocedural diplopia in guidelines is brief, and the exact incidence remains unknown. Different mechanisms for cranial nerve (CN) palsy have been postulated: incorrect technique, anatomical variations, and secondary heat injury. We observed postprocedural hemorrhage and hypothesized that bleeding might be a contributing factor in injury of CNs after RF-G.

Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers

1974 ◽  
Vol 40 (2) ◽  
pp. 143-156 ◽  
Author(s):  
William H. Sweet ◽  
James G. Wepsic
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Electrical Heating ◽  
Gasserian Ganglion ◽  
Foramen Ovale ◽  
Content Type ◽  
Corneal Scarring ◽  
Radiofrequency Heating ◽  
Neurological Morbidity ◽  
Fine Print

✓ The authors report their experience in the treatment of trigeminal neuralgia with controlled increments of radiofrequency heating from an electrode placed in the Gasserian ganglion or its posterior rootlets. Touch is preserved in some or all of a trigeminal zone rendered analgesic. The electrode tip is introduced through the foramen ovale and placed among the desired rootlets with the help of a combination of radiographs and the conscious patient's response to electrical stimulation with a square wave signal and gentle electrical heating. The degree of heat is measured by a thermister at the electrode tip. The patient's cooperation is maintained by the use of the neurolept anesthetic Innovar and the production of brief unconsciousness for the painful parts of the operation by methohexital (Brevital). Of 274 patients with facial pain so treated, 214 had trigeminal neuralgia; 91% of the latter group experienced relief of pain and 125 followed for 2½ to 6 years had a recurrence rate of 22%. In a total of 353 procedures, there has been no mortality and no neurological morbidity outside the trigeminal nerve. Only six of the patients with trigeminal neuralgia have complained significantly of postoperative paresthesias. The most serious undesired result has been the production of an anesthetic cornea in 28 patients, one of whom lost the sight of one eye due to corneal scarring. Correlating findings in our patients with those in studies by other authors, we conclude that the preservation of some touch is due to resistance to heating by the heavily myelinated A-beta fibers.

Computed Tomography-Guided Radiofrequency Thermocoagulation of the Gasserian Ganglion Using an Alternative to Hartel Anterior Approach: A Bicentral Study

2020 ◽  
Vol 3;23 (6;3) ◽  
pp. 293-298 ◽  
Author(s):  
Dimitrios K. Filippiadis
Keyword(s):  
Computed Tomography ◽  
Pain Relief ◽  
Anterior Approach ◽  
Anatomic Variation ◽  
Control Group ◽  
Complication Rates ◽  
Gasserian Ganglion ◽  
Ct Guided ◽  
Radiofrequency Thermocoagulation ◽  
Number Of Patients

Background: Trigeminal neuralgia (TN) is associated with multiple mechanisms involving peripheral and central nervous system pathologies. Among percutaneous treatments offered, radiofrequency thermocoagulation (RFT) is associated with longer duration of pain relief. Mostly due to anatomic variation, cannulation of the foramen ovale using the Hartel approach has a failure rate of 5.17%. Objectives: To report safety and efficacy of continuous RFT with an alternative to Hartel anterior approach under computed tomography (CT) guidance in patients with classic TN. Study Design: Retrospective institutional database review; bicentral study. Setting: Although this was a retrospective database research, institutional review board approval was obtained. Methods: Institutional database review identified 10 patients (men 8, women 2) who underwent CT-guided RFT of the Gasserian ganglion. Preoperational evaluation included physical examination and magnetic resonance imaging. Under anesthesiology control and local sterility measures, a radiofrequency needle was advanced, and its approach was evaluated with sequential CT scans. Motor and sensory electrostimulation tests evaluated correct electrode location. Pain prior, 1 week, 1, 3, and 6 months after were compared by means of a numeric visual scale (NVS) questionnaire. Results: Mean self-reported pain NVS score prior to RFT was 9.2 ± 0.919 units. One week after the RFT mean NVS score was 1.10 ± 1.287 units (pain reduction mean value of 8.1 units). At 3 and 6 months after thermocoagulation the mean NVS score was 2.80 ± 1.549 units and 2.90 ± 1.370 units, respectively. There were no postoperative complications. Three patients experienced facial numbness, which gradually resolved over a period of 1 month. Limitations: Retrospective nature; small number of patients; lack of a control group undergoing a different treatment of TN. Conclusions: Percutaneous CT-guided RFT of the Gasserian ganglion constitutes a safe and efficacious technique for the treatment of TN, with significant pain relief and minimal complication rates improving life quality in this group of patients. Key words: Trigeminal nerve, neuralgia, pain, radiofrequency, ablation, percutaneous, computed tomography, imaging

Unconventional Facial Entry Points Confirmed Using a 3D CT Reconstruction–Guided Stereotactic Approach to Radiofrequency Thermocoagulation for the Treatment of Trigeminal Neuralgia: A Series of Case Reports

Pain Medicine ◽  
2018 ◽  
Vol 20 (8) ◽  
pp. 1551-1558 ◽  
Author(s):  
Zhigang Guo ◽  
Zhijia Wang ◽  
Kai Li ◽  
Chao Du ◽  
Xingli Zhao ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Anatomical Variation ◽  
Preoperative Imaging ◽  
Gasserian Ganglion ◽  
Ct Reconstruction ◽  
Foramen Ovale ◽  
Radiofrequency Thermocoagulation ◽  
Patient Reported ◽  
Entry Points

Abstract Objectives Patients with trigeminal neuralgia who are refractory to medical therapy may choose to undergo Gasserian ganglion percutaneous radiofrequency thermocoagulation. However, in cases where the foramen ovale is difficult to access due to various anatomical anomalies, the typical estimation of the facial entry point is suboptimal. Methods Three-dimensional computed tomography reconstruction imaging performed before surgery revealed anatomical variations in each of the four adult patient cases that made it more difficult to successfully access the foramen ovale (FO) for percutaneous radiofrequency thermocoagulation. Using measurements collected from preoperative imaging that showed each specific anatomical variation in the FO, researchers marked alternate facial entry points that would allow successful probe placement into the FO and recorded the arc angle data in the stereotactic instrument. Results Patients were evaluated during follow-up visits ranging from seven to 26 months after surgery and asked to rate postoperative pain using a visual analog scale. These scores decreased from 10 to 3 in all four patients by the third day after the procedure. There were no permanent complications or morbidities from the surgery. One patient experienced mild facial numbness; however, this side effect subsided within three months after surgery. During the follow-up period, no patient reported pain recurrence. Conclusions The expectation for clinicians approaching trigeminal nerve block using a peri-oral approach should be to expect a great degree of potential variability in terms of both distances from the corner of the mouth and needle angle taken to successfully navigate the anatomy and access the foramen ovale.

Cavernous hemangioma of Meckel's cave

1988 ◽  
Vol 68 (4) ◽  
pp. 645-647 ◽  
Author(s):  
Michael G. Fehlings ◽  
William S. Tucker
Keyword(s):  
Cavernous Hemangioma ◽  
Vascular Malformation ◽  
Facial Pain ◽  
Gasserian Ganglion ◽  
Middle Fossa ◽  
Meckel’S Cave ◽  
Content Type ◽  
First Case ◽  
Meckel's Cave ◽  
Fine Print

✓ A case of a cavernous hemangioma located within Meckel's cave and involving the gasserian ganglion is described in a patient presenting with facial pain and a trigeminal nerve deficit. Although these lesions have been reported to occur in the middle fossa, this is believed to be the first case of such a vascular malformation arising solely from within Meckel's cave.

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