Percutaneous microcompression of the gasserian ganglion for trigeminal neuralgia

1990 ◽  
Vol 72 (4) ◽  
pp. 546-553 ◽  
Author(s):  
Ramiro D. Lobato ◽  
Juan J. Rivas ◽  
Rosario Sarabia ◽  
Eduardo Lamas
Keyword(s):  
Trigeminal Neuralgia ◽  
Intraluminal Pressure ◽  
Gasserian Ganglion ◽  
Fogarty Catheter ◽  
Short Operative Time ◽  
Content Type ◽  
Technical Errors ◽  
Early Failures ◽  
Anesthetic Complications ◽  
Fine Print

✓ The authors report 144 cases of trigeminal neuralgia treated by percutaneous microcompression of the trigeminal ganglion (PMTG). The operation was performed under short-lasting barbiturate anesthesia without endotracheal intubation. Meckel's cave was cannulated with a No. 4 Fogarty catheter and the balloon was inflated for 1 minute. The average intraluminal pressure required for adequate compression of the ganglion was about 1200 mm Hg. All patients were initially relieved of their neuralgia. In a follow-up period ranging from 6 months to 4½ years, 14 patients (9.7%) developed recurrence of pain between 10 and 35 months after surgery. Eleven patients underwent a second PMTG. All nine early failures and 10 of the 11 late recurrences occurred in cases with technical deficiencies. Most of the minor surgical complications observed were also related to avoidable technical errors. There were no anesthetic complications and no deaths. All patients developed mild to moderate postoperative hemifacial numbness with or without objective hypesthesia. Both subjective and objective deficits gradually diminished with time and were well tolerated. One year after the operation nearly 40% of the patients still had patches of slightly decreased sensation in one or more trigeminal divisions and 16% had mild dysesthesia. Anesthesia dolorosa or keratitis was not reported. The PMTG procedure is easy to perform and requires a short operative time and a brief period of hospitalization. It is well tolerated by patients, who describe it as a totally pain-free experience. Morbidity is minimal and recurrence of neuralgia does not seem to be higher than with alternative procedures.

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.

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.

Bilateral trigeminal neuralgia

1987 ◽  
Vol 67 (1) ◽  
pp. 44-48 ◽  
Author(s):  
Ronald Brisman
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Morbidity Rate ◽  
Gasserian Ganglion ◽  
Predisposing Factor ◽  
Content Type ◽  
Bilateral Involvement ◽  
Prior Surgery ◽  
Fine Print

✓ Bilateral trigeminal neuralgia occurred in 32 (11.9%) of 269 consecutive patients who were treated with radiofrequency electrocoagulation (RFE). This is a higher incidence than has been reported before and may be explained by the prospective nature of the present study, the long follow-up period, and the inclusion of patients with mild bilateral symptoms. Multiple sclerosis is the most common predisposing factor and occurred in 18% of those with bilateral trigeminal neuralgia. Although patients with bilateral trigeminal neuralgia were more likely to have had prior surgery than those with unilateral neuralgia, they did not have a higher recurrence rate following treatment. Percutaneous RFE of the retrogasserian rootlets and gasserian ganglion, with or without glycerol, is effective in managing patients whose pain is intractable to medical therapy. The preservation of most trigeminal sensory and motor functions, the low morbidity rate, and the ability to repeat the procedure are particularly advantageous for patients with bilateral involvement.

Trigeminal neuralgia: a quantitative sensory perception threshold study in patients who had not undergone previous invasive procedures

1997 ◽  
Vol 86 (2) ◽  
pp. 190-192 ◽  
Author(s):  
David Bowsher ◽  
John B. Miles ◽  
Carol E. Haggett ◽  
Paul R. Eldridge
Keyword(s):  
Trigeminal Neuralgia ◽  
Sensory Perception ◽  
Gasserian Ganglion ◽  
Invasive Procedures ◽  
Perception Threshold ◽  
Content Type ◽  
Idiopathic Trigeminal Neuralgia ◽  
Tactile Threshold ◽  
Fine Print ◽  
Von Frey Filaments

✓ The authors investigated 28 patients with “idiopathic” trigeminal neuralgia who had undergone no previous invasive procedures; together these patients had a total of 50 affected trigeminal divisions. Quantitative sensory perception thresholds were measured before operation. Preoperative measurements in the affected divisions indicated raised thresholds for touch (von Frey filaments) and temperature, but not for pinprick or heat pain, in agreement with the findings of Nurmikko. Only the tactile threshold was also significantly affected in the unaffected divisions on the affected side. The authors discuss their findings in relation to the pathophysiology of trigeminal neuralgia, concluding that the origin of the condition is almost certainly central to the gasserian ganglion.

Balloon Compression Rhizolysis in the Surgical Management of Trigeminal Neuralgia

Neurosurgery ◽  
1987 ◽  
Vol 20 (6) ◽  
pp. 908-913 ◽  
Author(s):  
Carl J. Belber ◽  
Richard A. Rak
Keyword(s):  
Trigeminal Neuralgia ◽  
Operative Time ◽  
Surgical Approaches ◽  
Gasserian Ganglion ◽  
Fogarty Catheter ◽  
Short Operative Time ◽  
Balloon Compression ◽  
Patients Experience ◽  
Endotracheal Anesthesia

Abstract To overcome some of the disadvantages of the current percutaneous surgical approaches to trigeminal neuralgia, we offer balloon compression rhizolysis (BCR) as an alternative. Guided by fluoroscopy, a 4 French Fogarty catheter is introduced into Meckl's cave, and its balloon is inflated tightly for a few minutes with soluble contrast agent to compress the gasserian ganglion and rootlets, under light endotracheal anesthesia. All patients experience immediate pain relief, with mild numbness in all three divisions, but with corneal sparing. Often, weakness of ipsilateral mastication appears transiently. In 33 procedures performed in 25 patients aged 48 to 86, with a follow-up period of 6 months to 7 years, there were 25 long-lasting cures (76%) and 8 recurrences. These results are fully comparable to those of other “destructive” procedures. There was no anesthetic complication and no mortality. The advantages of this procedure, besides its efficacy and low rate of dysesthesia, include absence of discomfort for the patient, short operative time, technical ease for the neurosurgeon, minimal morbidity, and no risk to corneal sensation. We think that microvascular decompression (MVD) should be the first operation considered for trigeminal neuralgia, but we advocate BCR as the procedure of choice in the aged and medically infirm, especially when V1 pain is present, in patients with multiple sclerosis, for recurrences after other procedures, and in virtually any situation in which MVD is, for some reason, not feasible.

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.

Long-term results of Gasserian ganglion electrocoagulation

1975 ◽  
Vol 42 (2) ◽  
pp. 140-143 ◽  
Author(s):  
Jürgen Menzel ◽  
Wolfgang Piotrowski ◽  
Helmut Penzholz
Keyword(s):  
Trigeminal Neuralgia ◽  
Long Term Results ◽  
Gasserian Ganglion ◽  
Content Type ◽  
Follow Up Study ◽  
Fine Print

✓ This report is a follow-up study of 315 patients under 46 years old who suffered from trigeminal neuralgia and were treated by electrocoagulation of the Gasserian ganglion. The average follow-up period was 12.7 years, the maximum 33 years. Eighty percent had a return of pain, but 96.7% ultimately attained freedom from pain after repeat electrocoagulation.

Needle for use during percutaneous compression of gasserian ganglion for trigeminal neuralgia

1989 ◽  
Vol 71 (3) ◽  
pp. 455 ◽  
Author(s):  
Arthur M. Gerber
Keyword(s):  
Trigeminal Neuralgia ◽  
Gasserian Ganglion ◽  
Content Type ◽  
Fine Print

✓ A needle system is described that facilitates the performance of percutaneous compression of the gasserian ganglion.

Unusual causes of trigeminal neuralgia treated by gamma knife radiosurgery

2002 ◽  
Vol 97 ◽  
pp. 533-535 ◽  
Author(s):  
Jin Woo Chang ◽  
Jae Young Choi ◽  
Young Sul Yoon ◽  
Yong Gou Park ◽  
Sang Sup Chung
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Fourth Ventricle ◽  
Gamma Knife Radiosurgery ◽  
Brain Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Segmental Demyelination ◽  
Content Type ◽  
Clinical Responses ◽  
Fine Print

✓ The purpose of this paper was to present two cases of secondary trigeminal neuralgia (TN) with an unusual origin and lesion location. In two cases TN was caused by lesions along the course of the trigeminal nerve within the pons and adjacent to the fourth ventricle. Both cases presented with typical TN. Brain magnetic resonance imaging revealed linear or wedge-shaped lesions adjacent to the fourth ventricle, extending anterolaterally and lying along the pathway of the intraaxial trigeminal fibers. The involvement of the nucleus of the spinal trigeminal tract and of the principal sensory trigeminal nucleus with segmental demyelination are suggested as possible causes for trigeminal pain in these cases. It is postulated that these lesions are the result of an old viral neuritis. The patients underwent gamma knife radiosurgery and their clinical responses have been encouraging to date.

Geometrical accuracy of the Novalis stereotactic radiosurgery system for trigeminal neuralgia

2004 ◽  
Vol 101 (Supplement3) ◽  
pp. 351-355 ◽  
Author(s):  
Javad Rahimian ◽  
Joseph C. Chen ◽  
Ajay A. Rao ◽  
Michael R. Girvigian ◽  
Michael J. Miller ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Trigeminal Neuralgia ◽  
Image Fusion ◽  
Stereotactic Radiosurgery ◽  
Ct Images ◽  
Radiochromic Film ◽  
Quality Assurance Program ◽  
Content Type ◽  
Geometrical Accuracy ◽  
Fine Print

Object. Stringent geometrical accuracy and precision are required in the stereotactic radiosurgical treatment of patients. Accurate targeting is especially important when treating a patient in a single fraction of a very high radiation dose (90 Gy) to a small target such as that used in the treatment of trigeminal neuralgia (3 to 4—mm diameter). The purpose of this study was to determine the inaccuracies in each step of the procedure including imaging, fusion, treatment planning, and finally the treatment. The authors implemented a detailed quality-assurance program. Methods. Overall geometrical accuracy of the Novalis stereotactic system was evaluated using a Radionics Geometric Phantom Chamber. The phantom has several magnetic resonance (MR) and computerized tomography (CT) imaging—friendly objects of various shapes and sizes. Axial 1-mm-thick MR and CT images of the phantom were acquired using a T1-weighted three-dimensional spoiled gradient recalled pulse sequence and the CT scanning protocols used clinically in patients. The absolute errors due to MR image distortion, CT scan resolution, and the image fusion inaccuracies were measured knowing the exact physical dimensions of the objects in the phantom. The isocentric accuracy of the Novalis gantry and the patient support system was measured using the Winston—Lutz test. Because inaccuracies are cumulative, to calculate the system's overall spatial accuracy, the root mean square (RMS) of all the errors was calculated. To validate the accuracy of the technique, a 1.5-mm-diameter spherical marker taped on top of a radiochromic film was fixed parallel to the x–z plane of the stereotactic coordinate system inside the phantom. The marker was defined as a target on the CT images, and seven noncoplanar circular arcs were used to treat the target on the film. The calculated system RMS value was then correlated with the position of the target and the highest density on the radiochromic film. The mean spatial errors due to image fusion and MR imaging were 0.41 ± 0.3 and 0.22 ± 0.1 mm, respectively. Gantry and couch isocentricities were 0.3 ± 0.1 and 0.6 ± 0.15 mm, respectively. The system overall RMS values were 0.9 and 0.6 mm with and without the couch errors included, respectively (isocenter variations due to couch rotation are microadjusted between couch positions). The positional verification of the marker was within 0.7 ± 0.1 mm of the highest optical density on the radiochromic film, correlating well with the system's overall RMS value. The overall mean system deviation was 0.32 ± 0.42 mm. Conclusions. The highest spatial errors were caused by image fusion and gantry rotation. A comprehensive quality-assurance program was developed for the authors' stereotactic radiosurgery program that includes medical imaging, linear accelerator mechanical isocentricity, and treatment delivery. For a successful treatment of trigeminal neuralgia with a 4-mm cone, the overall RMS value of equal to or less than 1 mm must be guaranteed.

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