Background and aims: Trigeminal neuralgia (TN) is a severe paroxysmal facial neuropathic pain with a significant impact on the quality of life and physical function of patients. The purpose of this pilot study was to provide preliminary data on the safety and efficacy of CT-guided, percutaneous radiofrequency ablation of the gasserian ganglion, for trigeminal neuralgia non responsive to conservative management.
Materials and methods: From 09/2016 to 12/2018 we treated 41 patients with intractable trigeminal neuralgia with CT-guided, percutaneous continuous radiofrequency ablation of the gasserian ganglion. All procedures were performed under CT guidance with local anaesthesia and sedation. A 22 gauge hybrid cannula with 5mm active tip was placed with its tip within the foramen ovale ipsilateral to the affected site. Motor and sensory test was performed to confirm the right placement of the needle. A post procedure CT was obtained to exclude any complications.
Results: Forty-one patients (28:13, F:M) were enrolled in the study. 33/41 patients mentioned significant immediate and sustained pain relief (>80% pain relief) after the procedure. 8/41 patients mentioned moderate pain relief (30-50%) while one patient had only minimal clinical improvement (< 20% pain relief). This particular patient refused reintervention. The rest 8 patients underwent a second session of pulsed radiofrequency with >80% pain relief. No complication was observed. In all 40 patients responding to treatment no further medical treatments were applied.
Conclusions: CT-guided gasserian ganglion continuous radiofrequency ablation is an effective treatment for trigeminal neuralgia non responsive to medical treatment. Risk profile is low.

CT-GUIDED, PERCUTANEOUS RADIOFREQUENCY ABLATION OF THE GASSERIAN GANGLION FOR TRIGEMINAL NEURALGIA