Background & Aims

Existing data favors microvascular decompression (MVD) for patients with trigeminal neuralgia that have arterial conflict (i.e., compression or contact) [1-6]. However, there are still some patients who have a recurrence of pain despite adequate arterial decompression of the nerve. The results of MVD for idiopathic TN (iTN) patients with venous contact only, or iTN patients with absent neurovascular contact (NVC), are less favorable, and MVD is not routinely recommended for these patients at our institution [1,4,6-8]. Repeat ablative procedures, including percutaneous retrogasserian glycerol rhizotomy, to treat trigeminal neuralgia (TN) can produce increasing unwanted side effects, including dysesthesia and ultimately anesthesia dolorosa. In an attempt to prevent this, we propose percutaneous block (PB) of the trigeminal ganglion (TG) with bupivacaine and depomedrol. The purpose of this study was to review the results and complications of treating TN with PB of the TG.

Methods

In a retrospective cohort study, we evaluated clinical outcomes and complications of PB of the TG in patients aged 18 years or older with classical TN secondary to arterial compression or iTN secondary to arterial contact (arterial group), and iTN secondary to venous contact only or absent neurovascular contact (venous/absent group). The MRI examinations were completed on a 3T MRI scanner (GE Healthcare) and were performed using a previously described cranial nerve protocol [4,6]. The primary outcomes were pain freedom at long-term follow-up and time to pain recurrence.

Results

Twenty-one PBs of the TG were performed in the arterial group and 20 in the venous/absent group. At a median follow up of 16.8 months, 14.3% of patients in the arterial group were pain free without medication. The median length of pain freedom without medication was 6.3 months. At a median follow up of 21.9 months, 25% of patients in the venous/absent group were pain free without medication. The median length of pain freedom without medication was 8.75 months.

Conclusions

This study suggests that patients with various types of TN may be treated safely with percutaneous bupivacaine and depomedrol block of the trigeminal ganglion to temporarily treat trigeminal neuralgia. This procedure presents an option for patients with debilitating pain when clinicians would like to avoid ablation.

References

[1].Andersen ASS, Heinskou TB, Rochat P, Springborg JB, Noory N, Smiklkov EM, Bendtsen L, Maarbjerg S. Microvascular decompression in trigeminal neuralgia – a prospective study of 115 patients. J Headache Pain. 2022;23(1):145.
[2]. Barker FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996;334(17):1077-1083.
[3]. Hardaway FA, Gustafsson HC, Holste K, Burchiel KJ, Raslan AM. A novel scoring system as a preoperative predictor for pain-free survival after microsurgery for trigeminal neuralgia. J Neurosurg. 2019:1-8.
[4]. Hughes MA, Jani RH, Fakhran S, Chang YF, Branstetter B, Thirumala P, Sekula RF. Significance of degree of neurovascular compression in surgery for trigeminal neuralgia. J Neurosurg. 2019:1-6.
[5].Maarbjerg S, Wolfram F, Gozalov A, Olesen J, Bendtsen L. Significance of neurovascular contact in classical trigeminal neuralgia. Brain. 2015;138(Pt 2):311-319.
[6].Panczykowski DM, Jani RH, Hughes MA, Sekula RF. Development and Evaluation of a Preoperative Trigeminal Neuralgia Scoring System to Predict Long-Term Outcome Following Microvascular Decompression. Neurosurgery. 2020;87(1):71-79.
[7].Leal PR, Froment JC, Sindou M. [MRI sequences for detection of neurovascular conflicts in patients with trigeminal neuralgia and predictive value for characterization of the conflict (particularly degree of vascular compression)]. Neurochirurgie. 2010;56(1):43-49.
[8].Leal PR, Barbier C, Hermier M, Souza MA, Cristino-Filho G, Sindou M. Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes. J Neurosurg. 2014;120(6):1484-1495.

Presenting Author

Margaret Tugend

Poster Authors

Margaret Tugend

BA

Columbia University

Lead Author

Raviteja Bethamcharla

BS

Lead Author

Kevin Patel

BS

Lead Author

Topics

  • Treatment/Management: Interventional Therapies – Injections/Blocks