Stimulation of the Gasserian ganglion in the treatment of refractory trigeminal neuropathy

Objectives: We evaluated the effectiveness of a custom-made neurostimulator with which to treat patients for refractory trigeminal neuropathic pain (TNP) at the level of the Gasserian ganglion.

Materials and methods: A retrospective analysis of 22 patients referred to our pain clinic, AZ Sint-Nikolaas, between 2010 and 2015, was conducted using the McGill Pain and EuroQoL questionnaire before, two weeks after, and at the final follow-up after neurostimulator treatment.

Results: Successful test stimulations were achieved for 77.3% of patients, with satisfactory long-term pain relief reported by 44% at 24 months. The predictive value of the trial stimulation was 80%, with 82.4% of patients reporting one or more complication, the most common being neck discomfort due to fibrosis. A small cohort size (22) limited our statistical analyses. However younger patients presented with a higher incidence of negative results after 24 months or physical complications. Cut-off ages were set at the age of 62 and 58 years respectively.

Conclusion: Stimulation of the Gasserian ganglion is a promising technique for the treatment of refractory TNP and should be considered ahead of more invasive techniques such as motor cortex or deep brain stimulation. The referral of refractory TNP patients should also be accomplished as early as possible to improve outcome.