Gasserian Ganglion Stimulation for Facial Pain. 2020

Dali Yin, and Konstantin V Slavin
Insight Institute of Neurosurgery and Neuroscience, Flint, Michigan, USA.

Non-neuralgic trigeminal neuropathic pain can be challenging in terms of treatment as pharmacological interventions often tend to be ineffective. Within the pain-transmitting pathway, the Gasserian ganglion (GG) is a rather unique anatomical and physiological structure where the sensory (including pain) information from the entire half of the face undergoes primary processing in a very compact and clearly defined entity. Moreover, GG is positioned in a completely immobile intradural location (the Meckel's cave) and is insulated from the brain by a layer of dura. As a confluence of all three trigeminal branches, GG allows one to achieve clinical effect on the entire half of the face with a relatively small surgical intervention while maintaining an ability to select exact facial regions based on known somatotopic organization of nerve fibers. Therefore, when it comes to electrical neuromodulation, the GG stimulation (GGS) may be a unique solution for treatment of medically refractory facial pain. GGS was introduced in 1970s and continues to be a recognized surgical modality with multiple published clinical series describing multi-year experience in hundreds of facial pain patients. GGS is particularly useful in treatment of patients with chronic trigeminal neuropathic pain and persistent idiopathic facial pain who tried and failed or were not considered good candidates for the conventional surgical interventions. With advances in lead technology, intraoperative visualization and stereotactic navigation, percutaneous GGS became a minimally invasive surgical intervention that is recommended for consideration in complex facial pain. Here, we review the clinical data and summarize the current state of GGS in facial pain treatment.

UI MeSH Term Description Entries
D004599 Electric Stimulation Therapy Application of electric current in treatment without the generation of perceptible heat. It includes electric stimulation of nerves or muscles, passage of current into the body, or use of interrupted current of low intensity to raise the detection threshold of the skin to pain. Electrotherapy,Electrical Stimulation Therapy,Interferential Current Electrotherapy,Therapeutic Electric Stimulation,Therapeutic Electrical Stimulation,Therapy, Electric Stimulation,Electric Stimulation, Therapeutic,Electrical Stimulation, Therapeutic,Electrotherapy, Interferential Current,Stimulation Therapy, Electric,Stimulation Therapy, Electrical,Stimulation, Therapeutic Electric,Stimulation, Therapeutic Electrical,Therapy, Electrical Stimulation
D005156 Facial Neuralgia Neuralgic syndromes which feature chronic or recurrent FACIAL PAIN as the primary manifestation of disease. Disorders of the trigeminal and facial nerves are frequently associated with these conditions. Facial Pain Syndromes,Sphenopalatine Neuralgia,Craniofacial Pain Syndromes,Myofacial Pain Syndromes,Craniofacial Pain Syndrome,Facial Neuralgias,Facial Pain Syndrome,Myofacial Pain Syndrome,Neuralgia, Facial,Neuralgia, Sphenopalatine,Neuralgias, Facial,Neuralgias, Sphenopalatine,Pain Syndrome, Craniofacial,Pain Syndrome, Facial,Pain Syndrome, Myofacial,Pain Syndromes, Craniofacial,Pain Syndromes, Facial,Pain Syndromes, Myofacial,Sphenopalatine Neuralgias,Syndrome, Craniofacial Pain,Syndrome, Facial Pain,Syndrome, Myofacial Pain,Syndromes, Craniofacial Pain,Syndromes, Facial Pain,Syndromes, Myofacial Pain
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012668 Trigeminal Ganglion The semilunar-shaped ganglion containing the cells of origin of most of the sensory fibers of the trigeminal nerve. It is situated within the dural cleft on the cerebral surface of the petrous portion of the temporal bone and gives off the ophthalmic, maxillary, and part of the mandibular nerves. Gasserian Ganglion,Semilunar Ganglion,Gasser's Ganglion,Trigeminal Ganglia,Ganglia, Trigeminal,Ganglion, Gasser's,Ganglion, Gasserian,Ganglion, Semilunar,Ganglion, Trigeminal,Gasser Ganglion,Gassers Ganglion,Semilunar Ganglions,Trigeminal Ganglias,Trigeminal Ganglions
D014277 Trigeminal Neuralgia A syndrome characterized by recurrent episodes of excruciating pain lasting several seconds or longer in the sensory distribution of the TRIGEMINAL NERVE. Pain may be initiated by stimulation of trigger points on the face, lips, or gums or by movement of facial muscles or chewing. Associated conditions include MULTIPLE SCLEROSIS, vascular anomalies, ANEURYSMS, and neoplasms. (Adams et al., Principles of Neurology, 6th ed, p187) Tic Doloureux,Tic Douloureux,Epileptiform Neuralgia,Fothergill Disease,Secondary Trigeminal Neuralgia,Trifacial Neuralgia,Trigeminal Neuralgia, Idiopathic,Trigeminal Neuralgia, Secondary,Disease, Fothergill,Epileptiform Neuralgias,Idiopathic Trigeminal Neuralgia,Idiopathic Trigeminal Neuralgias,Neuralgia, Epileptiform,Neuralgia, Idiopathic Trigeminal,Neuralgia, Secondary Trigeminal,Neuralgia, Trifacial,Neuralgia, Trigeminal,Secondary Trigeminal Neuralgias,Trifacial Neuralgias,Trigeminal Neuralgias
D058542 Implantable Neurostimulators Surgically placed electric conductors through which ELECTRIC STIMULATION of nerve tissue is delivered. Implanted Nerve Stimulation Electrodes,Implanted Neurostimulators,Implantable Neurostimulator,Implanted Neurostimulator,Neurostimulator, Implantable,Neurostimulator, Implanted,Neurostimulators, Implantable,Neurostimulators, Implanted

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