Stimulation of the Gasserian Ganglion for the Treatment of Refractory Trigeminal Neuralgia. Two Case Reports

Abstract

Background: Treatment of trigeminal neuralgia (TN) can be challenging for many physicians; patients who do not respond to conventional treatments and traditional surgical approaches often continue to suffer with pain. The peripheral nerve stimulator has been used to treat many chronic pain conditions, but few reports exist about its use to treat refractory TN through the stimulation of the Gasserian ganglion (GG). Case Report: We present 2 cases of patients with refractory TN who failed conventional medical and surgical management. Both patients were suitable candidates for a trial of peripheral nerve stimulation of the GG, both patients had positive results with the trials, and proceeded with permanent placement of the GG stimulator. In both cases we used deep brain stimulator leads, which were placed under fluoroscopy guidance through the foramen ovale onto the GG, and tunneled through the postauricular area to a pocket in the upper chest wall under the clavicle for the implantable pulse generator. Both of our patients experienced a significant symptomatic and functional improvement in their symptoms. The second patient was successfully weaned off her opioid pain medications after 6 months of treatment. Conclusion: Percutaneous stimulation of the GG is a promising technique for the treatment of refractory trigeminal neuropathic pain. More studies and experiences with this technique are needed to better demonstrate the efficacy and the safety profile, which potentially could allow this procedure to be considered ahead of the more invasive neurodestructive surgical treatments. Key words: Trigeminal neuralgia, Gasserian ganglion, peripheral nerve stimulator