Hanyang Med Rev.  2011 May;31(2):63-69. 10.7599/hmr.2011.31.2.63.

Trigeminal Neuralgia and Neural Blockade

• Shin KM

• KMID: 2168181
• DOI: http://doi.org/10.7599/hmr.2011.31.2.63

Abstract

Trigeminal neuralgia is characterized by recurrent episodes of intense lancinating pain affecting the face localized to the sensory supply areas of the trigeminal nerve. There is a lack of certainty regarding the etiology and pathophysiology of trigeminal neuralgia. The diagnosis of idiopathic typical trigeminal neuralgia requires the absence of clinically evident neurological deficit. Treatment must be individualized to each patient. Various trigeminal neural blockades can be options when medical therapy fails to relieve pain. Neural blockades include peripheral nerve branch blocks and intracranial nerve root or ganglion blocks such as RF thermocoagulation, percutaneous balloon compression and glycerol rhizolysis. Neural blockade with local anesthetics produces temporary effects, but neural blockade with neurolytics like alcohol lasts longer, around one or two years. They are very useful for patients with poor general condition or high risk. RF rhizotomy and balloon compression of trigeminal ganglion are relatively more invasive treatment options, but have more cost effectiveness with less serious complications compared to other surgical procedures. The continuous improvement of neural block techniques is necessary for better treatment of trigeminal neuralgia.

Keyword

Trigeminal neuralgia; Neural blockade; Radiofrequency rhizotomy

MeSH Terms

Anesthetics, Local
Cost-Benefit Analysis
Electrocoagulation
Ganglion Cysts
Glycerol
Humans
Peripheral Nerves
Rhizotomy
Trigeminal Ganglion
Trigeminal Nerve
Trigeminal Neuralgia
Anesthetics, Local
Glycerol

Figure

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  Fig. 1 Anteroposterior fluoroscopic view showing the RF cannula position for lesioning of the sphenopalatine ganglion.

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  Fig. 2 Right oblique submental fluoroscopic view showing the SMK cannula in the foramen ovale.

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  Fig. 3 Lateral fluoroscopic view showing the RF cannula tip just adjacent to the petroclival junction.

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  Fig. 4 Lateral view radiograph showing the balloon inflated in Meckel's cave.

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