Open AccessComputed Tomography-Guided Radiofrequency Thermocoagulation of the Gasserian Ganglion Using an Alternative to Hartel Anterior Approach: A Bicentral Study
Author(s) -
Dimitrios Filippiadis,
Dionysios Markoutsas,
Argyro Mazioti,
G Tsoukalos,
Olympia Papakonstantinou,
Panteleimon Stamatis,
Alexis Kelekis,
Dimitrios Tzavoulis
Publication year - 2020
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2020/23/293
Subject(s) - medicine , radiofrequency thermocoagulation , percutaneous , trigeminal neuralgia , retrospective cohort study , ganglion , surgery , radiology , anatomy
Background: Trigeminal neuralgia (TN) is associated with multiple mechanisms involvingperipheral and central nervous system pathologies. Among percutaneous treatments offered,radiofrequency thermocoagulation (RFT) is associated with longer duration of pain relief. Mostlydue to anatomic variation, cannulation of the foramen ovale using the Hartel approach has afailure rate of 5.17%.Objectives: To report safety and efficacy of continuous RFT with an alternative to Hartel anteriorapproach under computed tomography (CT) guidance in patients with classic TN.Study Design: Retrospective institutional database review; bicentral study.Setting: Although this was a retrospective database research, institutional review board approvalwas obtained.Methods: Institutional database review identified 10 patients (men 8, women 2) who underwentCT-guided RFT of the Gasserian ganglion. Preoperational evaluation included physical examinationand magnetic resonance imaging. Under anesthesiology control and local sterility measures, aradiofrequency needle was advanced, and its approach was evaluated with sequential CT scans.Motor and sensory electrostimulation tests evaluated correct electrode location. Pain prior, 1 week,1, 3, and 6 months after were compared by means of a numeric visual scale (NVS) questionnaire.Results: Mean self-reported pain NVS score prior to RFT was 9.2 ± 0.919 units. One week afterthe RFT mean NVS score was 1.10 ± 1.287 units (pain reduction mean value of 8.1 units). At 3 and6 months after thermocoagulation the mean NVS score was 2.80 ± 1.549 units and 2.90 ± 1.370units, respectively. There were no postoperative complications. Three patients experienced facialnumbness, which gradually resolved over a period of 1 month.Limitations: Retrospective nature; small number of patients; lack of a control group undergoinga different treatment of TN.Conclusions: Percutaneous CT-guided RFT of the Gasserian ganglion constitutes a safe andefficacious technique for the treatment of TN, with significant pain relief and minimal complicationrates improving life quality in this group of patients.Key words: Trigeminal nerve, neuralgia, pain, radiofrequency, ablation, percutaneous, computedtomography, imaging