Trigeminal neuropathy: Two case reports of gasserian ganglion stimulation

Abstract

This report describes the successful treatment of two patients with trigeminal neuropathy by using gasserian ganglion stimulation. Case reports:The first case report deals with a 53-year-old woman suffering from right-sided facial pain after a gamma knife lesion for schwannoma of the right inner ear. For 9 years, several interventions with the aim of relieving the pain were unsuccessful; in fact, they had aggravated the symptoms. A trial with a neurostimulator at the level of the Gasser ganglion had an immediately positive effect on her score for facial pain, which decreased from 7.3 to 0 on a visual analog scale, assessed during a period of 2 months. Additionally, the patient had weaned off all her medication by the end of the period. The second case report describes a 64-year-old man suffering from trigeminal neuropathy, which mainly manifested itself as an itch. For a period of 15 years, neither medication nor several interventions were effective. A trial with an electrode at the level of the Gasser ganglion reduced his pain score from 7.0 to 1.5 on a visual analog scale, assessed during a period of three months. His medication could be limited to pregabalin 150 mg bidaily. In contrast, prior to the implantation, his oral medication consisted of pregabalin 75 mg up to five times a day. Conclusion:These case reports show that stimulation of the gasserian ganglion is a successful, minimally invasive, and non-destructive treatment in refractory trigeminal neuropathy and should be considered earlier in the treatment algorithm of trigeminal neuropathy.

Efficacy and Safety of Pulsed Radiofrequency in Herpes Zoster Related Trigeminal Neuralgia: A Systematic Review and Meta-Analysis

“…Nevertheless, it is difficult for patients to benefit from neuro-destructive surgery as classical TN does. 11 , 12 Because these treatments were poorly effective, 73% of patients experienced more severe pain symptoms after surgery. 13 …”

Temporary Gasserian ganglion stimulation utilizing SNM electrode in subacute herpetic trigeminal neuralgia

“…Previous studies have reported undesirable outcomes where neuro-destructive interventions had little beneficial effect and exacerbated pain symptoms in 73% of patients ( 26 ). Furthermore, neuro-destructive surgery was also not recommended for patients with trigeminal neuropathy in other studies ( 19 , 20 ). The preferred and alternative forms of treatment for herpetic trigeminal neuralgia include neuromodulation techniques, such as pulsed radiofrequency, peripheral trigeminal nerve stimulation, or GGS.…”

“…First, the bipolar plate or 8-contact lead was being extensively applied in the treatment of trigeminal neuropathy at the level of Gasserian ganglion neuromodulation, but a high incidence of electrode dislocation and dysesthesia was reported. To solve the problem, Medtronic developed a custom-made tripolar-tined lead ( 19 , 20 ), but it was not available in China, which limited the use of this electrode. Second, if the trial stimulation was satisfactory, permanent electrode implantation was worth considering to ensure good pain control; however, this put a great financial burden on patients.…”

Trigeminal ganglion itself can be a viable target to manage trigeminal neuralgia

“…The TG, also known as the Gasserian ganglion, is a conjunction of all three trigeminal branches that permits one to designate precise facial areas based on the available somatotopic arrangement of nerve fibers while achieving a therapeutic effect on the full half of the face with minor surgical intervention. In refractory trigeminal neuropathy, stimulation of the Gasserian ganglion is an effective, minimally invasive, and non-destructive treatment that ought to be considered earlier in the treatment algorithm [ 31 ]. Despite a few risks, such as electrode dislocation (10–30%) and other mechanical defects (24%), TG electric stimulation has shown to be effective in treating patients with chronic trigeminal neuropathic pain and persistent idiopathic facial pain who have tried and failed or were not deemed candidates for standard surgical interventions [ 39 ].…”