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

Abstract

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.