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Trigeminal Nerve Blocks and Neurolysis

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Essentials of Interventional Techniques in Managing Chronic Pain

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Abstract

The trigeminal nerve block or neurolysis through the foramen ovale approach is used in the diagnosis and treatment of trigeminal neuralgia, which is a chronic neuropathic facial pain syndrome affecting millions of people worldwide. Idiopathic trigeminal neuralgia is primarily due to demyelination of trigeminal sensory fibers within either the nerve root or the brainstem. It is diagnosed based on typical signs and symptoms and exclusion of other causes of facial pain. Characteristic clinical presentation includes unilateral lancinating pain, paroxysmal attacks following neural disturbance, and a refractory period. The trigeminal nerve blocks and neurolysis are indicated in patients who have failed to respond to conservative treatments with medications. There are three procedures (radiofrequency thermocoagulation, balloon compression, and glycerolysis) that target the Gasserian ganglion and several procedures that target the branches of the trigeminal nerve. The neurodestructive procedures may produce long-term pain relief but can also cause numbness and dysesthesia in specific areas of trigeminal nerve innervation. Pulsed radiofrequency is a non-neurodestructive option but its efficacy is not as remarkable. Various treatment options should be weighed in risks and benefits, and the patients should be included in the decision-making process.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology and Pain Management, Mackay Memorial Hospital, Taipei, Taiwan

    Chia-Shiang (Sean) Lin

  2. Department of Pain Management, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA

    Jianguo Cheng

Authors
  1. Chia-Shiang (Sean) Lin
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  2. Jianguo Cheng
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Correspondence to Jianguo Cheng .

Editor information

Editors and Affiliations

  1. Pain Management Center of Paducah, Paducah, Kentucky

    Laxmaiah Manchikanti

  2. Department of Anesthesia, LSU Health Science Center, New Orleans, Louisiana, USA

    Alan D. Kaye

  3. Mid Atlantic Spine and Pain Physicians, Newark, Delaware

    Frank J.E. Falco

  4. Service Line Chief of Interventional Radiology, Director of Interventional Neuroradiology, Chief of NeuroInterventional Spine Service, Massachusetts General Hospital, Boston, Massachusetts, USA

    Joshua A. Hirsch

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(Sean) Lin, CS., Cheng, J. (2018). Trigeminal Nerve Blocks and Neurolysis. In: Manchikanti, L., Kaye, A., Falco, F., Hirsch, J. (eds) Essentials of Interventional Techniques in Managing Chronic Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-60361-2_26

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  • DOI: https://doi.org/10.1007/978-3-319-60361-2_26

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60359-9

  • Online ISBN: 978-3-319-60361-2

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