Pressor and depressor responses in thermocoagulation of the trigeminal ganglion

We have undertaken a retrospective analysis in 126 patients with trigeminal neuralgia on which a free-hand percutaneous thermocoagulation of the Gasserian ganglion was performed in our department. We focused on the occurrence of intraoperative vagal reactions, i.e. significant bradycardia and changes in blood pressure during the course of the procedure. Operative and anaesthetic records of patients who underwent the procedure were evaluated and correlated with clinical data from the patient's history. We observed the occurrence of vagal reactions i.e. significant bradycardia (< 50/min) or syncope in 20% of patients (p < 0.0002) during or immediately after penetration of the foramen ovale. No correlation between the operated side and the occurrence of vagal reactions was found. A significant rise in blood pressure levels (about 180 mmHg systolic) was observed in 36% of patients during thermocoagulation. We concluded that painful stimuli arising from lesioning in the course of the trigeminal nerve reach the mid-brain and may irritate the dorsal nucleus of the vagus nerve resulting in significant bradycardia or cardiac synode. To prevent haemodynamic deterioration i.v. atropine (0.5-2 mg) should be available when advancing the needle, while anti-hypertensive medication (Esmolol) may be needed during coagulation.