Indication: Trigeminal Neuralgia
The first choice for treatment of trigeminal neuralgia is carbamazepine. It can be used with other medication such as baclofen.
Gasserian ganglion lesions are indicated when patients fail other medication treatments. These procedures include radiofrequency thermocoagulation, balloon compression, and glycerolysis.
Radiofrequency thermocoagulation is the most commonly used procedure. This procedure is often performed by neurosurgeons, interventional pain specialists or interventional radiologists. The treatment requires inserting a radiofrequency needle through the face and foramen ovale into the base of the skull under the guidance of fluoroscopy or CT. After the needle reaches the Gasserian ganglion, radiofrequency energy is applied to induce thermocoagulation; 87% to 91% of patients experience immediate pain relief.
In a five-year follow up, 50% patients still had good pain relief. Common side effects of this technique include corneal anesthesia, masticator weakness and anesthesia dolorosa.
Recently, stereotactic radiosurgery for trigeminal neuralgia has been used more widely due to its non-invasive nature; 59% to 70% of patients have complete pain relief in a one- to two-year follow up. However, this procedure may be more costly than other procedures mentioned above.