Download Trigeminal (Gasserian) Ganglion Block

Trigeminal (Gasserian) Ganglion
Block
• Dr. S. Parthasarathy
• MD., DA., DNB, MD (Acu), Dip. Diab.
DCA, Dip. Software statistics
• PhD (physio)
• Mahatma Gandhi medical college
and research institute – puducherry,
India
Indications
• Diagnostic for facial neuralgia
• Anaesthesia of surgery of the face
• Patients with severe underlying
cardiopulmonary disease who require more
than minor facial surgery
• 1 to 3 mL of local anesthetic
Anatomy
• The trigeminal ganglion is located
intracranially and measures 1 × 2 cm.
• In its intracranial location, it lies lateral to
the internal carotid artery and cavernous
sinus and slightly posterior and superior to
the foramen ovale, through which the
mandibular nerve leaves the cranium
Anatomy- three divisions
Anatomy
• The trigeminal ganglion is partially
contained within a reflection of dura mater,
Meckel's cave.
• Three divisions
• Sensory , sensory, and partially motor
Position
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supine position
Fixed gaze straight
Anaesth . Stands by the side
Clench teeth
Identify medial border of masseter
3 cm lateral to corner of the mouth
Sluijter-Mehta-Kanula cannula, 10 cm 22 G
with a 2 mm active tip.
Technique
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Plane of zygoma and mandibular arch
10-cm needle is inserted
Plane of pupil
Aided by fluoroscopy
sphenoid bone
4.5 – 6 cm
Foramen ovale -6-7
Technique
technique
Fluoro
Another fluoro image
Technique
• Mandibular paresthesia- insufficient
• Some more insertion – elicit paresthesia in
maxillary or ophthalmic area
• Aspirate - CSF – nil – 1 ml then wait for 5
minutes then give 1 ml
• No CSF
• 40 mg methylprednisolone, 4 mg
dexamethasone, or 40 mg triamcinolone
acetate – addition
TIPS
• Initially, the needle is directed downward
and laterally. Then, the needle is aimed
medially for the foramen ovale to avoid
mouth entry.
• One finger should be placed in the mouth to
prevent intraoral entry of the needle.
• Prophylactic antibiotics and sedation with
midazolam and fentanyl are advised.
• 2-3 ml syringe
Radiofrequency
• generation of a pulsed electromagnetic field
radiofrequency at 42°C for a 120-second
cycle times two to three cycles.
• Standard radiofrequency neurolysis can also
be performed at 67°C for 90 seconds.
associated with a risk of sensory loss in the
trigeminal nerve distribution.
Other techniques
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compression using a Fogarty-type
balloon.
More recently, surgical microvascular
decompression and gamma knife irradiation
of the nerve have been introduced.
Other drugs
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Alcohol
Glycerol
6 % phenol
With or without omnipaque
Cryo
Complications
• CSF
• Vascular injury
• Painful procedure
• No time pressure
Other described complications
• Masticator muscle weakness,
• corneal analgesia,
• seizure, coma, keratitis, bacterial
meningitis, carotid fistula, intracranial
hemorrhage, diplopia, death, and facial or
subscleral hematoma.
Thank you all
• The agony of pain
is gone and the
patient will smile
like