Percutaneous microcompression of the gasserian ganglion for trigeminal neuralgia

The authors report 144 cases of trigeminal neuralgia treated by percutaneous microcompression of the trigeminal ganglion (PMTG). The operation was performed under short-lasting barbiturate anesthesia without endotracheal intubation. Meckel's cave was cannulated with a No. 4 Fogarty catheter and the balloon was inflated for 1 minute. The average intraluminal pressure required for adequate compression of the ganglion was about 1200 mm Hg. All patients were initially relieved of their neuralgia. In a follow-up period ranging from 6 months to 4 1/2 years, 14 patients (9.7%) developed recurrence of pain between 10 and 35 months after surgery. Eleven patients underwent a second PMTG. All nine early failures and 10 of the 11 late recurrences occurred in cases with technical deficiencies. Most of the minor surgical complications observed were also related to avoidable technical errors. There were no anesthetic complications and no deaths. All patients developed mild to moderate postoperative hemifacial numbness with or without objective hypesthesia. Both subjective and objective deficits gradually diminished with time and were well tolerated. One year after the operation nearly 40% of the patients still had patches of slightly decreased sensation in one or more trigeminal divisions and 16% had mild dysesthesia. Anesthesia dolorosa or keratitis was not reported. The PMTG procedure is easy to perform and requires a short operative time and a brief period of hospitalization. It is well tolerated by patients, who describe it as a totally pain-free experience. Morbidity is minimal and recurrence of neuralgia does not seem to be higher than with alternative procedures.