MIPSI or Minimally invasive pain and spine interventions is a broad term which encompasses all the Non-invasive and minimally invasive interventions done by the interventional spine and pain physicians for myriad of conditions right from Musculo-skeletal disorders like back pain, neck pain, knee pain etc.
What is Gasserian ganglion and where is it situated?
Gasserian ganglion, also known as Trigeminal ganglion or Semilunar ganglion is a large crescent shaped collection of cell bodies of the sensory root of the Trigeminal nerve.
It is situated in the Trigeminal cave or Meckel’s cave which is a small depression in the petrous part of temporal bone of the skull.
From this ganglion, 3 divisions of Trigeminal nerve emerge and travel anteriorly and inferiorly. These are Ophthalmic, Maxillary and Mandibular nerve from anterior to posterior. These 3 divisions supply various parts of the face. There can be involvement of only 1 or all the divisions of the Ganglion at a single point of time.
What is the procedure of Gasserian ganglion Radiofrequency neurectomy?
Gasserian ganglion Radiofrequency neurectomy is an advanced procedure which involves the precise identification of the exact pathological division of gasserian ganglion with the help of sensory and motor stimulation and then targeted ablation of these nerves using Radiofrequency current.
Access to this ganglion is achieved through the Foramen Ovale which is a small opening at the base of the skull. This opening is identified using a Fluoroscope machine and then a radiofrequency needle is inserted from the cheek of the patient targeting this foramen.
Whole procedure is done under local anaesthesia with some mild sedation.
What are the Indications of Gasserian ganglion neurectomy?
- Trigeminal neuralgia
- Atypical facial pain
- Oral cancer with persistent oro-facial pain
How Gasserian ganglion neurectomy MIPSI helps relief pain?
Gasserian ganglion Radiofrequency neurectomy mainly acts by 2 mechanisms:
Peripheral Wallerian degeneration of the nerve: Due to the application of Radiofrequency currents , the friction between the various tissue molecules generate thermal energy which burns the nerves and brings about what is called as conduction block. So these nerves stop conducting pain signals from the affected site towards the brain where pain stimulus is actually processed and patient feels immediate relief from pain.
Central neuromodulation: Chronic pain has a component of Central Sensitization where in there is amplification of the pain signals in the brain and patients experience pain even in the absence of any movements or painful stimulus. With application of Radiofrequency ablation there is modulation in these central neural circuitries and the central sensitization is abolished.
How early the beneficial effects can be seen?
Patient can start appreciating the effect of the procedure on the procedure table itself post-procedure and maximal effect is achieved over a period of 3-4 weeks.
How many times this procedure has to be repeated?
The effect of this procedure can last from about 2 years to 5 years, after which this procedure has to be repeated. During this pain free period patient becomes drug free and thus escapes from the side effects of these medications which occur due to prolonged use of the drugs.
Will I require hospitalization for this procedure?
Yes. Patient generally is hospitalized for a period of 24 hours post-procedure for observation.
To see how this procedure is done, click the below link