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Radiofrequency Ablation at Gasserian Ganglion in Trigeminal Neuralgia

A.M. Rajgure, Atharva 55 A. Swapna Nagari, Vijay Chowk, Garkheda, Aurangabad – 431009 Maharashtra, India. , Arvind Rajgure1 , Ashok Deshmukh2 , Annasaheb Mhaske2

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Indian Journal of Anesthesia and Analgesia 4(3):p 575-579, July - September 2017. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.4317.3

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Abstract

Introduction: Trigeminal neuralgia (TGN), is a neurological condition affecting the sensory division of the fifth cranial (i.e., trigeminal) nerve and is characterized by recurrent episodes of severe, shock-like pain confined to the distribution of one or more of the nerve’s three branches. TGN is characterized by sharp, shooting, ‘electric shock-like’ pain sensation that is limited to one or more branches of the trigeminal nerve. Medical line of treatment consists of oral carbamazepine as the main and most effective first line of treatment. Microvascular decompression (MVD) with craniotomy is a surgical procedure with having excellent results. Radiofrequency ablation [7-11] of one or more branches of trigeminal nerve at Gasserian ganglion is one of the best minimally invasive treatment with equally effective as MVD. Its day care procedure performed under light sedation and local anesthesia. Aim and Objectives: The study was aimed to evaluate the efficacy of single radiofrequency thermocoagualtion (RFT) and objective to compare the success rates and its complications. Materials and Methods: A total number of 56 patients with trigeminal neuralgia, of age ranging from 50 to 75 years of age attending the pain clinic during June 2011 to December 2016 were studied. The conventional radiofrequency current was used for ablation at Gasserian ganglion. The patients were followed for first, third and fifth year after procedure. Results: The mean age of patients was 56 ± 4yrs. Patients with single branch involvement were 35 (62.5%) and patients having three branches involved were 06 (10.71%). Excellent pain relief was achieved in 53 (94.64%) patients at the end of the first year follow, 50 (89.28%) patients had pain relief at the end of 3 years and 46 (82.14%) patients had pain relief at the end of 5 years. Out of the 10 (10%) patients those had pain recurrence: 7 (70%) patients had medical treatment to control pain satisfactory and 3 (30%) patients underwent additional surgery, including repeat RFT. Total 13(23.21%) patients had different degrees of facial numbness immediately after RFT; that disappeared gradually on follow. While 9(16.07%) patients experienced mastication difficulties that improved during the follow-up and 8(14.28%) patients had headache. Conclusion: It was concluded that RFT is a safe and effective procedure for TN patients. Facial numbness should be considered as an expected side effect rather than an unexpected complication. Patients who have pain in all 3 trigeminal divisions and patients who desire no facial numbness should be cautious. Medical therapy remains the first line in the treatment of TN.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.4317.3

Keywords

Trigeminal; Neuralgia; Radiofrequency; Ablation; Gasserion Ganglion.

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