Gasserian Ganglion Radiofrequency Ablation for Trigeminal Neuralgia: A Resident’s Experience of 23 Consecutive Cases and the Procedural Learning Curve

Abstract

Background: Trigeminal neuralgia is a severe neuropathic pain disorder characterized by recurrent paroxysmal facial pain in the distribution of one or more divisions of the trigeminal nerve. Although pharmacological therapy remains the initial treatment, patients with refractory symptoms or medication intolerance may require interventional treatment. Percutaneous procedures targeting the Gasserian ganglion, particularly radiofrequency (RF) thermocoagulation, provide an effective minimally invasive option. ^[1,2]

Percutaneous access to the Gasserian ganglion through the foramen ovale is technically demanding and requires familiarity with skull-base fluoroscopic anatomy and three-dimensional needle trajectory. This is particularly relevant during residency training in interventional pain medicine. ^[2,11]

Objective: To describe our experience with 23 consecutive percutaneous procedures for trigeminal neuralgia, predominantly Gasserian ganglion Radiofrequency ablation, with particular emphasis on clinical outcome, duration of pain relief, technical successand the progressive acquisition of fluoroscopic and needleplacement skills by residents.
Methods: A retrospective descriptive review was performed of 23 consecutive patients undergoing percutaneous treatment for trigeminal neuralgia at our institution. Twenty-two patients underwent Gasserian ganglion RF ablation, and one patient underwent balloon compression. The affected trigeminal division, duration of pain relief, technical success, clinical success, and resident participation in identification of the foramen ovale and needle placement were documented. ^[1,2]

Of the 23 patients, 4 had V1 involvement, 2 had V2 involvement, and 17 had V3 involvement. Technical success was defined as successful completion of the intended percutaneous procedure, while clinical success was defined according to meaningful post-procedural pain relief as documented during follow-up. ^[1]

Results: All 23 procedures were technically successful and all 23 patients achieved clinical success. The mean duration of pain relief was approximately 18 months, with a median duration of 18 months, ranging from 2 weeks to 3 years. ^[3,5]

Residents were able to independently identify the foramen ovale in 14 of 23 cases (60.9%). Independent needle placement into the foramen ovale was achieved in 10 of 23 cases (43.5%). The data demonstrated a progressive improvement in resident procedural capability over the case series, with independent needle placement occurring in the later cases. ^[12,13]

Conclusion: Our experience demonstrates that Gasserian ganglion RF ablation can provide substantial and prolonged pain relief in appropriately selected patients with trigeminal neuralgia. Importantly, the series also demonstrates a progressive resident learning curve in fluoroscopic identification of the foramen ovale and percutaneous needle placement. Structured supervision, repeated exposure to skull-base fluoroscopic anatomyand correlation of radiological landmarks with three-dimensional needle trajectory appear to be important components of training in this technically demanding procedure. ^[3,4,5]