Anesth Pain Med.  2023 Apr;18(2):132-138. 10.17085/apm.22225.

Computed tomography-guided Gasserian ganglion interventions for cancer-related facial pain in patients with complex anatomy: insights and recommendations

• González-Casarez AI
• Santamaría-Montaño GG
• Plancarte-Sánchez R
• Guillén-Núñez MR
• Juárez-Lemus ÁM
• Hernández-Porras BC
• Samano-García M
• Rocha-Romero A

• KMID: 2543654
• DOI: http://doi.org/10.17085/apm.22225

Abstract

Background
The Gasserian ganglion is a well-known target for facial pain management, and patients with cancer present an anatomical challenge owing to tumor progression or treatment itself. Computed tomography (CT) is an alternative method for guiding these procedures.
Methods
This was an observational retrospective analysis of patients with cancer-related facial pain who underwent CT-guided Gasserian ganglion interventions using local anesthetics, local anesthetics with steroids, phenol, and radiofrequency. Demographic, clinical, and procedure-related variables were collected from January 1, 2015, to December 30, 2018, at the National Cancer Institute. Data distribution was determined using the Kolmogorov–Smirnov test. A paired sample t-test (with a cut-off of P < 0.05 for statistical significance) was used for comparing outcome.
Results
We observed a significant reduction in numerical rating scale (NRS) and douleur neuropathique 4 (DN4) scores from 7.6 ± 1.4 and 4.4 ± 1.4 to 3.2 ± 2.0 and 2.2 ± 1.4 points, respectively (P < 0.001). After the procedure, 70.8% of the patients were satisfied; 16.7% were very satisfied, and 12.5% were unsatisfied. No intra- or postoperative complications were observed. The most common neoplasms were head and neck tumors (83.3%).
Conclusions
Our data suggest that CT guidance is an effective and safe option for managing cancer-related facial pain in patients with complex anatomy, resulting in a significant reduction in pain, high satisfaction rates, and no mechanical complications. Future research should aim to refine the role of CT guidance in multimodal pain management in this population.

Keyword

Cancer pain; Facial pain; Gasserian ganglion; Neoplasm

Figure

• 

  Fig. 1. Computed tomography of head and neck tumors showing complex anatomy.

• 

  Fig. 2. Three-dimensional reconstruction showing the computed tomography-guided bilateral approach.

Reference

1. Mirzadeh Z, Sheehy JP, Ben-Haim S, Rosenberg WS. Neurosurgical management of cancer facial pain. Prog Neurol Surg. 2020; 35:170–80.

2. Reddy GD, Wagner K, Phan J, DeMonte F, Raza SM. Management of skull base tumor-associated facial pain. Neurosurg Clin N Am. 2016; 27:337–44.

3. Huygen F, Kallewaard JW, van Tulder M, Van Boxem K, Vissers K, van Kleef M, et al. "Evidence-based interventional pain medicine according to clinical diagnoses": update 2018. Pain Pract. 2019; 19:664–75.

4. Lambru G, Zakrzewska J, Matharu M. Trigeminal neuralgia: a practical guide. Pract Neurol. 2021; 21:392–402.

5. Cruccu G, Di Stefano G, Truini A. Trigeminal neuralgia. N Engl J Med. 2020; 383:754–62.

6. Sindou M, Tatli M. [Treatment of trigeminal neuralgia with glycerol injection at the gasserian ganglion]. Neurochirurgie. 2009; 55:211–2. French.

7. Roychoudhury P, Romero AR, Raslan A, Abd-Elsayed A. Peripheral neurectomy for treatment of trigeminal neuralgia. Trigeminal nerve pain. In : Abd-Elsayed A, editor. Cham: Springer;2021. p. 207–14.

8. Bick SKB, Eskandar EN. Surgical treatment of trigeminal neuralgia. Neurosurg Clin N Am. 2017; 28:429–38.

9. Wang JY, Bender MT, Bettegowda Ch. Percutaneous procedures for the treatment of trigeminal neuralgia. Neurosurg Clin N Am. 2016; 27:277–95.

10. Guo Z, Wu B, Du C, Cheng M, Tian Y. Stereotactic approach combined with 3D CT reconstruction for difficult-to-access foramen ovale on radiofrequency thermocoagulation of the gasserian ganglion for trigeminal neuralgia. Pain Med. 2016; 17:1704–16.

11. Hartel F. Die leitungsanesthesie und injektionsbehandlung des ganglion gasseri und der trigeminusaeste. Arch Klin Chir. 1912; 100:193–292.

12. Zheng C, Yitong J, Zipu J, Tao W, Fang L. The long-term outcome of 3-dimensional CT-guided percutaneous radiofrequency thermocoagulation for tumor-related trigeminal neuralgia. Pain Physician. 2019; 22:E467–75.

13. Sun Z, Liu L, Liu H, Luo F. Effect of CT-guided gasserian ganglion block with local anesthetics and steroids on acute/subacute zoster-related trigeminal neuralgia: a multicenter retrospective study. J Pain Res. 2022; 15:2303–13.

14. Telischak NA, Heit JJ, Campos LW, Choudhri OA, Do HM, Qian X. Fluoroscopic C-arm and CT-guided selective radiofrequency ablation for trigeminal and glossopharyngeal facial pain syndromes. Pain Med. 2018; 19:130–41.

15. Bendtsen L, Zakrzewska JM, Heinskou TB, Hodaie M, Leal PRL, Nurmikko T, et al. Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol. 2020; 19:784–96.

16. Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G. Trigeminal neuralgia - diagnosis and treatment. Cephalalgia. 2017; 37:648–57.

17. Xu R, Xie ME, Jackson CM. Trigeminal neuralgia: current approaches and emerging interventions. J Pain Res. 2021; 14:3437–63.

18. Tang YZ, Yang LQ, Yue JN, Wang XP, He LL, Ni JX. The optimal radiofrequency temperature in radiofrequency thermocoagulation for idiopathic trigeminal neuralgia: a cohort study. Medicine (Baltimore). 2016; 95:e4103.

19. Texakalidis P, Xenos D, Tora MS, Wetzel JS, Boulis NM. Comparative safety and efficacy of percutaneous approaches for the treatment of trigeminal neuralgia: a systematic review and meta-analysis. Clin Neurol Neurosurg. 2019; 182:112–22.

20. Wang Z, Su X, Yu Y, Wang Z, Li K, Gao Y, et al. A review of literature and meta-analysis of one-puncture success rate in radiofrequency thermocoagulation with different guidance techniques for trigeminal neuralgia. Eur J Med Res. 2022; 27:141.