Gasserian Ganglion For Trigeminal Neuralgia Research Articles

Neuronavigation assisted percutaneous balloon compression of the gasserian ganglion for trigeminal neuralgia. How I do it

BackgroundSurgical treatment for trigeminal neuralgia includes percutaneous techniques, including balloon compression, first described in 1983 by Mullan and Lichtor (J Neurosurg 59(6):1007–1012, 6).MethodHere we present a safe and simple navigation-assisted percutaneous technique for balloon compression, which can also be used for glycerol injection.ConclusionThe navigation-assisted percutaneous technique for balloon compression for trigeminal neuralgia is a quick and safe treatment for patients not candidates for microvascular decompression.

Safety and Efficacy of Radiofrequency Ablation of Gasserian Ganglion in Trigeminal Neuralgia

Background: Trigeminal neuralgia (TN) is characterized by intractable pain in one or more division of trigeminal nerve. Pharmacologic management is first line treatment for TN, when it fails interventional treatment options are considered like percutaneous procedures or micro vascular decompression. Radio frequency thermoscoagulation is an effective option for medically refractory cases to control pain.Objective: To evaluate the safety and efficacy of Radiofrequency thermocoagulation of the gasserian ganglion for the treatment of trigeminal neuralgia.Methods: Total 44 patients were included in this prospective obsarvational study who were already diagnosed with trigeminal neuralgia and refractory to medical management. All patients were treated by radiofrequency thermocoagulation after confirming the position of needle tip by sensory and motor stimuli. Three lesions were created at 60-70oC for 90 second each. Patients were assessed for pain relief, corneal reflex, numbness and masticatory muscle weakness at immediate post procedural stage, 1 week, 1 month and at 6 months.Results: Twenty eight patients had pain over both mandibular (V3) and maxillary (V2) division, 12 patients had mandibular (V3) and 4 patients had only maxillary (V2) division involvement. Excellent pain relief was archived in 38 (86.36%) patients, 4 patients (9.09%) have good pain control and 2 (4.54%) patient developed poor pain control with development of Anesthesia dolorosa in 1 patient. None of them develop complete facial numbness, 41 patients developed tolerable numbness and 2 patients develop somewhat bothersome, Facial numbness. Three patients developed unilateral masseter muscle weakness however no patients developed corneal ulcers, blindness or other complications.Conclusion: Temperature controlled thermocoagulation is a safe and effective treatment options for trigeminal neuralgia.

Expect the Unexpected!! – Transient Cranial Nerve Palsies after Radiofrequency Ablation of Gasserian Ganglion for Trigeminal Neuralgia

Trigeminal neuralgia is the most common type of craniofacial neuralgia, characterized by paroxysmal lancinating electric shock-like pain confined to the somatosensory distribution of the trigeminal nerve. Fluoroscopy-guided Radiofrequency Ablation of Gasserian Ganglion (RFA-GG) is the commonly performed minimally invasive pain intervention in these patients. Various complications such as masseter weakness, corneal anesthesia, dysesthesia, anesthesia dolorosa, keratitis, and cranial nerve deficits have been reported during the procedure. We present the case of a 58-year-old male diagnosed with left-sided trigeminal neuralgia involving mandibular division of trigeminal nerve (V3 division) with a Numerical Rating Scale of 9/10 at the time of presentation. As the patient was unresponsive to medical management, RFA of the V3 division of GG was performed with acceptable sensory and motor stimulation. Postablation, 1 ml of 1.0% Lidocaine injection with 2 mg injection dexamethasone was given. After the procedure, the patient complained of dizziness, left-sided hearing loss, and double vision on looking toward the left side. On examination, deviation of the angle of the mouth toward the right side, reduced blink reflex on the left side, and incomplete closure of the left eyelid were observed. Vitals were stable and there was no respiratory discomfort. The patient was reassured and monitored in the recovery room. Signs and symptoms were transient and the patient recovered completely after 45 min. Clinical findings were suggestive of the involvement of three cranial nerves: the abducens nerve, the facial nerve, and the vestibulocochlear nerve. Spillage of local anesthetic solution into adjacent cranial nerves surrounding the GG might be the causative mechanism for transient cranial nerve palsies in this case.

Radiofrequency Thermocoagulation of the Gasserian Ganglion for Trigeminal Neuralgia using a Stereotactic Approach due to a Pterygoalar Bar

AbstractThe treatment of trigeminal neuralgia (TN) consists of pharmacotherapy and neurosurgical procedure, such as percutaneous radiofrequency rhizotomy. Here, we present the case of a patient with TN refractory to clinical treatment who presented an anatomical variation in the oval foramen, which required stereotactic-guided surgery to access the Gasser ganglion.This is a 63-year-old male patient who presented with TN refractory to drug treatment. He used carbamazepine and nortriptyline, with no satisfactory response. The percutaneous approach to radiofrequency thermocoagulation was indicated, in view of the comorbidities presented and the patient's age. Due to the presence of a rare anatomical variation, stereotactic-guided surgery was used to cannulate the foramen ovale and, thus, successfully perform the neurosurgical procedure with an excellent clinical response. The use of stereotaxy to guide cannulation of the foramen ovale due to anatomical variation was essential for the success of the procedure. The knowledge of the existence of this anatomical variation, and the mastery of the stereotactic technique enabled the adequate management in the face of the unusual situation.

Long‐term recurrence‐free survival and complications of percutaneous balloon compression and radiofrequency thermocoagulation of Gasserian ganglion for trigeminal neuralgia: A retrospective study of 1313 cases

To estimate long-term recurrence, complications after percutaneous balloon compression (PBC) and radiofrequency thermocoagulation (RFT) of gasserian ganglion among a large sample of patients with trigeminal neuralgia (TN) during a long-term follow-up. A retrospective analysis of 1313 patients undergoing PBC or RFT for the treatment of TN was conducted from 2006 to 2020. Recurrence-free survival (RFS) was assessed by the Kaplan-Meier method. Complications including facial numbness, corneal reflex decrease and masseter weakness were also estimated. For patients who received first initial PBC and RFT, the median RFS was 130.1months (95% CI: 124.4, 135.9) and 123.3months (95% CI: 117.6, 128.9) in PBC and RFT group with log-rank p=0.108. The RFS rate was, respectively, 90.6% (95% CI: 88.1%-93.3%) and 91.4% (95% CI: 89.1%-93.7%) at 1year, 84.6% (95% CI: 81.4%-87.8%) and 83.3% (95% CI: 80.3%-86.3%) at 3 years, 81.5% (95% CI: 78.1%-85.0%), and 78.6% (95% CI: 75.2%-81.9%) at 5 years, 71.5% (95% CI: 67.5%-75.5%), and 64.8% (95% CI: 61.0%-68.7%) at 10 years in two groups. No significant difference was observed in facial numbness degree between two groups after procedure. Compared with PBC group, ophthalmic complication prevalence was higher in RFT group (9.6%) (p=0.001). However, masseter weakness incidence was lower (10.7%) than that in PBC group (24.0%) with p < 0.001. Patients with TN seemed to attain similar long-term benefit from PBC and RFT, especially in elderly. However, in order to reduce postoperative complications, PBC provided a safer and alternative for treating TN involving ophthalmic division, whereas RFT could be employed as a preferred regimen for maxillary and mandibular TN.

Application of Augmented Reality in Percutaneous Procedures-Rhizotomy of the Gasserian Ganglion.

BACKGROUNDPercutaneous rhizotomy of the Gasserian ganglion for trigeminal neuralgia is an effective therapeutic procedure. Yet, landmark-guided cannulation of the foramen ovale is manually challenging and difficult to learn.OBJECTIVETo overcome these limitations, we assessed the feasibility and accuracy of an augmented reality (AR)-guided puncture of the foramen ovale.METHODSA head phantom with soft tissue structures of the facial area was built. A three-dimensional (3D)-dataset of the phantom was generated using a stereotactic planning workstation. An optimal trajectory to the foramen ovale was created and then transferred to an AR headset. A total of 2 neurosurgeons and 2 neuroradiologists independently performed 8 AR-guided and 8 landmark-guided cannulations of the foramen ovale, respectively. For each AR-guided cannulation, the hologram was manually aligned with the phantom. Accuracy of the cannulation was evaluated using the Euclidean distance to the target point as well as the lateral deviation of the achieved trajectory from the planned trajectory at target point level.RESULTSWith the help of AR guidance, a successful cannulation of the foramen ovale was achieved in 90.6% compared to the purely landmark-based method with 18.8%. Euclidean distance and lateral deviation were significantly lower with AR guidance than landmark guidance (P < .01).CONCLUSIONAR greatly improved accuracy of simulated percutaneous rhizotomy of the Gasserian ganglion.

Radiofrequency Ablation at Gasserian Ganglion in Trigeminal Neuralgia

Radiofrequency Ablation at Gasserian Ganglion in Trigeminal Neuralgia

Stereotactic Approach Combined with 3D CT Reconstruction for Difficult-to-Access Foramen Ovale on Radiofrequency Thermocoagulation of the Gasserian Ganglion for Trigeminal Neuralgia.

The authors describe a technique that includes a stereotactic approach in the preoperative plan in cases where the foramen ovale is difficult to access for radiofrequency thermocoagulation of the Gasserian ganglion. The study included 395 patients for whom three-dimensional computed tomographic reconstruction of the skull base, maxilla, and mandible was conducted before surgery. Accessibility of the foramen ovale was defined using numerical data from the three-dimensional computed tomographic reconstruction images. In those patients for whom accessibility of the foramen ovale was considered difficult, the authors used a stereotactic frame to design an individual operative plan. Adjustments of a single point of data,-that is, a change in X axis, Y axis, or an arc angle-were guided by radiographic fluoroscopy images. After verifying successful cannulation and electroneurophysiology, thermocoagulation targets-especially multiple targets recorded as data on the Z axis of the stereotactic approach-were identified and treated. There were 24 patients who met the predetermined criteria for having a difficult-to-access foramen ovales-that is, they had at least two contributing factors and/or involvement of division V1 . Twenty-one of the 24 patients required a single satisfactory puncture; three patients required two to three punctures to successfully access the foramen ovale. There were no permanent complications from the procedure. The authors conclude that this stereotactic approach combined with three-dimensional computed tomographic reconstruction model can improve the accuracy, safety, and efficiency of percutaneous radiofrequency thermocoagulation in patients with trigeminal neuralgia for whom the foramen ovale is difficult to access.

Effect of Previous Herpes Zoster on Radiofrequency Thermocoagulation of Gasserian Ganglion for Trigeminal Neuralgia

Effect of Previous Herpes Zoster on Radiofrequency Thermocoagulation of Gasserian Ganglion for Trigeminal Neuralgia

Pulsed radiofrequency treatment of the Gasserian ganglion in trigeminal neuralgia: a 10 year retrospective analysis

Pulsed radiofrequency treatment of the Gasserian ganglion in trigeminal neuralgia: a 10 year retrospective analysis

Variable size percutaneous balloon compression of the gasserian ganglion for trigeminal neuralgia

Background Percutaneous balloon compression of the gasserian ganglion is an effective management of trigeminal neuralgia and is the only percutaneous procedure that preferentially may be performed under general anesthesia. However, the anatomy of Meckle's cave dictates the degree of compression, and if capacious, the usual smaller balloons may fail to adequately compress the ganglion. Methods We designed a series of larger cannulas, placed over a guidewire technique for using larger balloons, or even multiple balloons, to increase the applicability of this technique in these patients. Results In select cases, where smaller balloons fail to distort and deform the ganglion, with resultant poor clinical results, larger or multiple balloons may produce the desired response of pain relief. Conclusion This technique is an added resource in managing this condition.

Acute subdural and intratemporal hematoma as a complication of percutaneous compression of the gasserian ganglion for trigeminal neuralgia

Acute subdural and intratemporal hematoma as a complication of percutaneous compression of the gasserian ganglion for trigeminal neuralgia

Acute subdural and intratemporal hematoma as a complication of percutaneous compression of the gasserian ganglion for trigeminal neuralgia

The case of a 68 year-old man who developed a fatal intracranial hemorrhagic complication following percutaneous compression of the gasserian ganglion for trigeminal neuralgia is reported. The complication was likely related to improper placement of the Fogarty catheter into the temporal fossa out of the Meckel's cave. The anatomical structures at risk of damage by misplaced needle or catheter and some relevant technical details aimed to prevent extratrigeminal complications related with this and other percutaneous trigeminal lesioning procedures are analyzed.

Analysis of Ballon Volumes Used during Percutaneous Microcompression of the Gasserian Ganglion for Trigeminal Neuralgia in Korean Patients

Analysis of Ballon Volumes Used during Percutaneous Microcompression of the Gasserian Ganglion for Trigeminal Neuralgia in Korean Patients

Long-term results of percutaneous compression of the gasserian ganglion in trigeminal neuralgia (series of 200 patients).

The aim of the present study was to evaluate the long-term results of a series of 200 patients operated on by percutaneous compression of the gasserian ganglion (PCGG) according to Mullan and Lichtor's technique. The balloon was inflated for 6 min with 0.7 cm3 of iopamiro. We report excellent and satisfactory results in 62.5% of the cases and recurrence in 32.5% with a mean follow-up of 51 months. Severe sensory complications were rare (3%), whereas hearing disturbances were more frequent (11%). One unfortunate postoperative death was reported. With acceptable morbidity and in spite of this death, PCGG is an effective method which can easily be repeated in the treatment of trigeminal neuralgia.

Percutaneous balloon compression of the Gasserian ganglion in trigeminal neuralgia. Long-term results in 150 cases.

One hundred and fifty patients with trigeminal neuralgia were treated by percutaneous compression of the Gasserian ganglion (PCGG) during the last 8 years. The technique is the one described by Mullan with the balloon inflated during 6 minutes with 0,7 cc of contrast medium. Over a follow-up period ranging from 6 months to 8 years with an average of 4 years, one hundred and four patients (69,3%) have remained painfree. Postoperative complications included dysaesthesias in 16 patients (moderate in 15), hypo-aesthesia in 140 (moderate in 138), hypo-acousia and otalgia in ten, and masticatory weakness also in ten. The recurrence rate was 30%. The main advantages of the procedure are exceptionally severe dysaesthesias (one case), the rarity of corneal complications (4 cases), the short hospital stay (three days on average). Its disadvantage is the need for a general anaesthetic. This study shows that percutaneous compression is efficacious and technically easy.

Needle for use during percutaneous compression of gasserian ganglion for trigeminal neuralgia. Technical note.

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

Percutaneous compression of the gasserian ganglion for trigeminal neuralgia

Percutaneous compression of the gasserian ganglion for trigeminal neuralgia

Landmark article April 28, 1900: A method of total extirpation of the Gasserian ganglion for trigeminal neuralgia. By a route through the temporal fossa and beneath the middle meningeal artery. By Harvey Cushing.

Landmark article April 28, 1900: A method of total extirpation of the Gasserian ganglion for trigeminal neuralgia. By a route through the temporal fossa and beneath the middle meningeal artery. By Harvey Cushing.

A Method of Total Extirpation of the Gasserian Ganglion for Trigeminal Neuralgia

Of the many diseases which, on therapeutic grounds, are supposed to occupy a border-line position between the provinces of the physician and surgeon, perhaps no one more than intractable epileptiform neuralgia illustrates so well the dictim of that renowned Philadelphian and friend of many doctors, Benjamin Franklin, to the effect that he is the best physician who knows the worthlessness of the most medicines. Granting the premise in all cases of true tic douloureux, the neuralgia quinti major of Henry Head, in which all three divisions of the trigeminal nerve are affected, that surgical measures alone can with any degree of certainty be depended on to afford relief from this horrible affliction and that the removal of the Gasserian ganglion must ultimately be contemplated, it is to be regretted that this final procedure should generally be regarded as one hazardous in its performance and uncertain in its permanent effects. Two