Gasserian Ganglion Block
If you suffer from headaches, Trigeminal Neuralgia, facial pain or atypical facial pain, this advanced treatment option may be right for you. The gasserian ganglion is a central access point for all sensation from the face – in essence, a gasserian ganglion block can effectively block pain at the source before it travels to the brain, and give people their lives back.
There are 12 special nerves that connect directly with the brain called “Cranial Nerves.” Each of these nerves has a special function for our basic senses. The one that is responsible for sensation in the forehead and face is the Trigeminal Nerve, or the 5th cranial nerve (it is often abbreviated “V,” which is the roman numeral for the number 5) As the name implies, there are 3 branches that come off of the Trigeminal Nerve. Each of the 3 branches are connected at the base of the Trigeminal Nerve by a structure called the “Gasserian Ganglion.”
A Gasserian Ganglion Block (aka Trigeminal Nerve Block) is not a new procedure. However, due to the relative complexity of the procedure itself, it may not be readily offered by every doctor simply because not every doctor is capable of performing it. As such, when seeking care from a medical professional, patients may not find it to be as common as other treatments for facial pain.
While it is most commonly used for Trigeminal Neuralgia, it can also be effectively utilized for a variety of other types of facial pain:
The Trigeminal Nerve
Trigeminal neuralgia is the direct result of injury to the trigeminal nerve. In fact, advancing research increasingly implicates the entire trigeminal complex in almost all known facial pain. The trigeminal nerve is the 5th cranial nerve and it governs facial sensation and the muscles involved in mastication (chewing).
Like all cranial nerves the trigeminal nerve is paired and present on both sides of the body. The trigeminal nerve, however consists of three paired branches emanating from the nerve root. Hence the name “three-twins” (tri=three, geminal=twinned) The three branches are the opthalmic, the maxillary, and the mandibular. Each branch exits the skull through separate foramina (openings) and innervates different parts of the head.
Ophthalmic (V1)– Eyebrows, forehead, scalp, eye, upper eyelid.
Maxillary (V2) – Cheeks, lip, nostrils, lower eyelid, upper teeth
Mandibular (V3 – Lower teeth, lower lip, jaw and chin
Each branch can be responsible for transmitting pain. The ganglion (root where the 3 branches come together to enter the brain) can be responsible for perpetuating pain, and the whole trigeminal system itself can also be responsible for spreading pain to other nerves.
The Gasserian Ganglion sits at the base of the skull and is located within a structure called the “Foramen Ovale” – this is accessible with a needle. Using a fluoroscope or CT-scan, your doctor will be able to see where the Foramen Ovale is located. A small amount of local anesthetic is used to numb the area of your cheek, about an inch or so from the crease of your mouth. Then, under real-time X-ray guidance or CT-guidance, your doctor will advance the needle until it enters the Foramen Ovale. A small amount of contrast dye is injected to make sure the needle is in the proper position. Once everything is confirmed to be correct, a few cc’s of local anesthetic is injected onto the Gasserian Ganglion and the needle is removed. It’s that simple.
While sedation is not required for this procedure, most patients prefer it due to ease and comfort.
A Gasserian Ganglion Black has 3 basic functions:
- Diagnostic: To determine if the pain is being generated by or traveling through the root of the Trigeminal Nerve.
- Prognostic: To determine if a neurolytic procedure (i.e. radiofrequency ablation or chemoneurolysis) on the Gasserian Ganglion would be beneficial.
- Therapeutic: In some cases, simply turning the Gasserian Ganlgion off for a few hours with local anesthetic may be beneficial by itself and can be enough to treat the pain.
This entirely depends on the patient and the severity of the symptoms. Generally speaking, your doctor will typically recommend 2 diagnostic blocks to properly diagnose whether or not the Gasserian Ganglion as a pain generator or pathway for your pain. A “positive” response can be either a sustained or temporary reduction in pain of at least 50%. If the relief is temporary, the next step will likely be an ablation or some sort of procedure aimed at disrupting the ganglion and its ability to transmit pain signals.
After a successful blockade of the Gasserian Ganglion and Trigeminal Nerve, there will be numbness one side of your face that may last for a few hours, depending on the anesthetic used. This is the indication of a successfully performed “block.”
After the procedure is completed there are several possible outcomes:
- Your pain is improved or even eliminated for several days after the effect of the anesthetic wears off. This indicates the procedure had an obvious therapeutic value and offers some insight into the process causing pain, guiding the future treatment plan to maximize pain control.
- There is the sensation of warmth in the leg (evidence of a successful sympathetic blockade), however there is no pain relief. This means the block was successful however the lack of pain relief will be of diagnostic value to your doctor. This will equally guide your physician’s decision making when coming up with future treatment plans.
- There is no sensation of warmth in the leg and there is no pain relief. This indicates the block was not performed correctly and may need to be repeated to properly assess whether or not the pain is driven by the sympathetic nervous system.
This procedure generally well tolerated. Complications from a gasserian ganglion block are rare but can occur. The most common side effects are post procedural discomfort which can be worsened by bleeding should the needle come into contact with a blood vessel. Other possible complications include infection, nerve damage and worsening headaches should the needle piece the sac around the brian causing cerebrospinal fluid to leak. While a gasserian ganglion block is relatively straightforward, it does require a certain skill set and level of experience that should not be overlooked when choosing a doctor to administer it. As such, it should only be performed by a physician with proper training.
If you suffer from chronic facial pain that has failed to resolve with medications and other conservative therapies, this treatment may be an option for you. A Gasserian Ganglion Block should not only be performed under the strict supervision of a board-certified pain management specialist, but only by someone with formal training in this procedure.
Contact the Ainsworth Institute to set up an initial evaluation to find out if you are a candidate for a Gasserian Ganglion Block.
The Ainsworth Institute is Here to Help
If you are suffering from chronic facial pain and would like to see if you could be a candidate for this exciting treatment option, contact the Ainsworth Institute of Pain Management today. Schedule an appointment with one of our Board Certified Physicians to learn more about Gasserian Ganglion Blocks.