Trigeminal neuralgia treated by differential percutaneous radiofrequency coagulation of the Gasserian ganglion

1974 ◽  
Vol 40 (4) ◽  
pp. 517-523 ◽  
Author(s):  
G. Robert Nugent ◽  
Bruce Berry
Keyword(s):  
Trigeminal Neuralgia ◽  
Percutaneous Penetration ◽  
Anesthetic Techniques ◽  
Gasserian Ganglion ◽  
Foramen Ovale ◽  
Content Type ◽  
The Face ◽  
Touch Sensation ◽  
Radiofrequency Coagulation ◽  
Radiographic Landmarks

✓ The authors describe surgical and anesthetic techniques for the treatment of trigeminal neuralgia by radiofrequency coagulation. Using radiographic landmarks derived from a stereotaxic study of 54 cadaver skulls, they delineate lateral and anteroposterior guidelines which aid in the percutaneous penetration of the foramen ovale. Controlled lesions can be made selectively in any division of the trigeminal nerve. The procedure has been effective in abolishing pain usually with preservation of touch sensation in the face. The percutaneous operation has the added advantage of a short hospitalization, usually 2 days. Of the 65 patients treated, only one still has the pain of trigeminal neuralgia. In six instances the procedure had to be repeated because insufficient sensory deficit was produced by the initial lesion. Three patients have developed anesthesia dolorosa; however, none has developed facial paralysis.

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.

Trigeminal neuralgia treated by radiofrequency coagulation

1983 ◽  
Vol 59 (3) ◽  
pp. 479-484 ◽  
Author(s):  
John P. Latchaw ◽  
Russell W. Hardy ◽  
Sarah B. Forsythe ◽  
Allan F. Cook
Keyword(s):  
Trigeminal Neuralgia ◽  
Demographic Data ◽  
Clinical Results ◽  
Sensory Loss ◽  
Gasserian Ganglion ◽  
Previous Response ◽  
Content Type ◽  
Duration Of Illness ◽  
Previously Treated ◽  
Radiofrequency Coagulation

✓ Ninety-six patients underwent percutaneous radiofrequency coagulation (RC) of the Gasserian ganglion for relief of trigeminal neuralgia between 1973 and 1978. Fifty-two percent of patients who were followed for 5 years were free of recurrence after a single RC procedure. Factors predicting clinical results were sought from initial historical and demographic data. Age, sex, duration of illness, and previous response to medication were unrelated to outcome. Patients previously treated by open surgery appeared to receive less benefit from subsequent RC. The RC procedure seemed more effective in the treatment of patients with classical tic douloureux than in those with atypical features. The degree of sensory loss created by RC was associated with the clinical outcome. Patients acquiring dense sensory deficits demonstrated a reduced risk of recurrence (p = 0.006): 25% of patients with dense sensory loss and 55% of those with a partial deficit developed a recurrence by 5 years, whereas all patients without initial sensory loss suffered a recurrence by 5 years.

Improved visualization of the foramen ovale for percutaneous approaches to the gasserian ganglion

1994 ◽  
Vol 80 (1) ◽  
pp. 156-159 ◽  
Author(s):  
Arthur M. Gerber
Keyword(s):  
Trigeminal Neuralgia ◽  
Radiation Exposure ◽  
Gasserian Ganglion ◽  
Foramen Ovale ◽  
Content Type ◽  
Percutaneous Procedures ◽  
Radiopaque Markers ◽  
Radiological Studies ◽  
Fine Print

✓ Percutaneous procedures for treating trigeminal neuralgia involve the penetration of foramen ovale using cutaneous landmarks and radiological guidance. The placement of radiopaque markers over the commonly used “zygomatic points” in front of the ears provides landmarks on intraoperative radiological studies that facilitate localization of the foramen ovale. Speed and safety of percutaneous trigeminal procedures should be enhanced. There is no increase in radiation exposure over that in other commonly used approaches.

Evaluation of endorphin content in the CSF of patients with trigeminal neuralgia before and after Gasserian ganglion thermocoagulation

1981 ◽  
Vol 55 (6) ◽  
pp. 935-937 ◽  
Author(s):  
Giuseppe Salar ◽  
Salvatore Mingrino ◽  
Marco Trabucchi ◽  
Angelo Bosio ◽  
Carlo Semenza
Keyword(s):  
Cerebrospinal Fluid ◽  
Trigeminal Neuralgia ◽  
Control Group ◽  
Gasserian Ganglion ◽  
Content Type ◽  
Group Of Seven ◽  
Idiopathic Trigeminal Neuralgia ◽  
Significant Difference ◽  
Before And After ◽  
Fine Print

✓ The β-endorphin content in cerebrospinal fluid (CSF) was evaluated in 10 patients with idiopathic trigeminal neuralgia during medical treatment (with or without carbamazepine) and after selective thermocoagulation of the Gasserian ganglion. These values were compared with those obtained in a control group of seven patients without pain problems. No statistically significant difference was found between patients suffering from trigeminal neuralgia and those without pain. Furthermore, neither pharmacological treatment nor surgery changed CSF endorphin values. It is concluded that there is no pathogenetic relationship between trigeminal neuralgia and endorphins.

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.

Vasodilator system for the face

1975 ◽  
Vol 42 (6) ◽  
pp. 696-703 ◽  
Author(s):  
Guillermo Gonzalez ◽  
Burton M. Onofrio ◽  
Frederick W. L. Kerr
Keyword(s):  
Brain Stem ◽  
Trigeminal Ganglion ◽  
Content Type ◽  
Moderate Number ◽  
Trigeminal Nuclei ◽  
The Face ◽  
Greater Superficial Petrosal Nerve ◽  
Radiofrequency Coagulation ◽  
The Brain ◽  
Stimulation Of

✓ The authors describe investigations in cats to delineate a vasodilator system to the face, which they undertook after a previous study showed that radiofrequency coagulation of the trigeminal ganglion produced a pronounced flush in the skin of the corresponding division. Results demonstrate a vasodilator system emerging from the brain stem with the facial nerve which, by way of the greater superficial petrosal nerve, reaches the trigeminal ganglion. There the fibers are distributed to each of the divisions of the fifth nerve; in addition, a moderate number of vasodilator fibers also appear to leave the brain stem directly with the trigeminal nerve. Vasodilator effects were elicited by stereotaxic stimulation of the facial and trigeminal nuclei in the brain stem. There is, therefore, a dual vasomotor control of the facial cutaneous vascular bed; the classical sympathetic vasoconstrictor system of the face is complemented by a vasodilator system capable of producing changes of equal but opposite amplitude in vessel caliber.

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

Percutaneous retrogasserian glycerol injection in the management of trigeminal neuralgia: long-term follow-up results

1990 ◽  
Vol 73 (2) ◽  
pp. 212-216 ◽  
Author(s):  
Takamitsu Fujimaki ◽  
Takanori Fukushima ◽  
Shinichiro Miyazaki
Keyword(s):  
Trigeminal Neuralgia ◽  
Content Type ◽  
Kaplan Meier ◽  
Glycerol Injection ◽  
Sensory Disturbances ◽  
Long Term Follow Up ◽  
The Face ◽  
Median Pain

✓ The results in 122 patients with trigeminal neuralgia who underwent percutaneous retrogasserian glycerol injection are presented. Eighty patients were followed from 38 to 54 months. The recurrence rate at 54 months was 72% (Kaplan-Meier analysis), and the median pain-free interval was 32 months. Complications associated with the procedure were significantly high: 63% of the patients had definite hypesthesia of the face and 29% had unpleasant dysesthesias, including two cases of anesthesia dolorosa. Sensory disturbances were most frequent in patients who had received a previous alcohol block procedure. Among the patients without previous peripheral procedures, 50% developed sensory disturbances. Because of the high rates of recurrence and sensory disturbances, the authors prefer microvascular decompression for the management of trigeminal neuralgia.

scholarly journals Pain Intervention for Trigeminal Neuralgia

2017 ◽  
Vol 16 (1) ◽  
Author(s):  
MA. Hadi ◽  
A. Nor Zamzila ◽  
AGM Rasydan ◽  
N Suhaila ◽  
IM Nizamuddin
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Sensory Stimulation ◽  
Pharmacological Therapy ◽  
Gasserian Ganglion ◽  
First Line Therapy ◽  
First Case ◽  
Pain Intervention ◽  
The Face ◽  
Pulse Radiofrequency

In the management of chronic pain, stepwise oral analgesics of graded strength are considered as first-line therapy. Minimally invasive interventional procedures remain an option for its treatment when pharmacological therapy fails to control the pain. We reported three classical cases of chronic trigeminal neuralgia that were managed with two types of pain intervention approaches after failing conservative management. In the first case, percutaneous pulse radiofrequency was directed directly to the trigeminal nerve while the other two patients were approached through Gasserian Ganglion. The first method used a traditional technique of pulse radiofrequency approaches. The nerve was identified using sensory stimulation and pulse radiofrequency was delivered once the nerve was confirmed. The second method was similar to the first one but with different approach. Under fluoroscopic control, a radiofrequency needle was introduced into the cheek’s skin ipsilateral to the pain. The needle was directed towards the cranial base in front of the foramen ovale. The success of a trigeminal nerve block depends on proper identification of the anatomic landmarks and the nerve itself. The two different approaches of pain interventions offer more than 50% pain reduction. The trigeminal nerve approaches offer less risk as compared to Gasserian ganglion which is nearer to the brainstem and subarachnoid area. These procedures offer the ability to limit the sensory deficit to a preselected region of the face and to produce hypoalgesia or analgesia without anesthesia.

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