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Two cases of Gasserian ganglion neurinomas in children are described. The onset in both cases was insidious and the tumors became very large before the first clinical signs appeared. Blindness of one eye by direct compression of the homolateral optic nerve was the main symptom in both instances. In one child homolateral exophthalmus was also present. The clinical course of both cases was completely painless and without any other sign of involvement of the trigeminal nerve. Abnormal vessels related to the tumor were visible in the arterial phase of carotid angiography. This angiographic finding (unique in appearance and distribution) may be considered as pathognomonic for tumors of the Gasserian ganglion.

A rare tumor closely associated with the trigeminal ganglion produced a syndrome of atypical facial pain in a 44-year-old man. Two previous reports have designated similar tumors as "fibro-osseous lesions." The distinctive morphological appearance is illustrated and possible histogenesis discussed.

37 procedures were carried out in 32 patients with trigeminal neuralgia who were unrelieved by anticonvulsants. Initial relief was achieved in 31 patients (98%). 5 patients (16%) suffered a relapse during a follow-up period of 15-26 months. Corneal anaesthesia occurred in 6 patients, 1 of whom subsequently developed a corneal ulcer. Anaesthesia dolorosa appeared in 5 patients. Ipsilateral reduction in hearing was reported by 2 patients. Despite its limits and complications percutaneous radio frequency gangliolysis is an effective alternative in the treatment of trigeminal neuralgia.

In 250 patients with tic doulourex an percutaneous radiofrequency coagulation of the gasserian ganglion has been performed. In 92.2% of the cases the patients were post-operatively painfree. The follow-up extended in 122 cases over 7 years. In these patients a pain recurrency was noted in 27%. On behalf of low invasivity of the procedure the radio-frequency coagulation of the gasserian ganglion is a recommendable operation with low risk and high efficiency especially in old patients.

The effectiveness of percutaneous microcompression of the gasserian ganglion, performed according to the technique proposed by Mullan and Lichtor, was evaluated in 74 patients affected by essential trigeminal neuralgia and compared to the results obtained with the RF thermocoagulation of Sweet and Wepsic. Similar results were obtained with the two methods but adverse side-effects were less common with microcompression. It is concluded that the microcompression should be recommended as a first choice among the different percutaneous procedures in the treatment of trigeminal neuralgia.

Five hundred patients with trigeminal pain underwent percutaneous thermocoagulation of the Gasserian ganglion. Of these 416 had classical trigeminal neuralgia, 49 had atypical facial pain and 35 had symptomatic trigeminal neuralgia. The patients ranged in age from 20 to 92 years. These patients have been followed for from eight to 57 months. The beneficial results of this operation and the complications are presented.

Marked hyperemia may develop in brain following temporary cessation of blood flow and is associated with the morbidity following cardiac arrest, stroke, and head injury. Regional cerebral blood flow was measured using radiolabeled microspheres and compared in 10 symmetrical regions after chronic unilateral trigeminal ganglionectomy (n = 8), trigeminal rhizotomy (n = 4), or sham operation (n = 4) following 10 min of combined brachiocephalic-left subclavian occlusion and hypotension (mean arterial blood pressure less than 50 mmHg) in cats. Blood flow was symmetrical at rest in the three groups and was undetectable during the ischemic period. Within 30 min after re-establishing flow, values in cortical gray matter increased symmetrically to approximately 250 ml.100 g-1.min-1 in the rhizotomy and the sham groups. Increases of similar magnitude were measured on the intact side following trigeminal ganglionectomy but flow was attenuated by greater than 50% ipsilateral to the ganglionectomy. Marked hyperemia developed during reperfusion in thalamus, caudate, deep cortical white matter, midbrain, and pons, but no asymmetries were present in the three groups. These data suggest that cortical hyperemia is mediated by trigeminal neurogenic mechanisms via axonal reflexlike mechanisms and suggest the importance of therapeutic strategies based on blockade of this nerve or its constituent neuropeptides.

In a series of patients with trigeminal neuralgia (TN) who were treated with radiofrequency electrocoagulation of the gasserian ganglion and retrogasserian rootlets, either alone or with glycerol, 16 patients with TN and multiple sclerosis (TNMS) are compared with 219 patients with TN without MS. Patients with TNMS were younger and more likely to have bilateral facial pain than those with TN alone. Probability of ipsilateral recurrence was calculated on the basis of Kaplan and Meier product-limit estimates and showed no significant differences in the two groups.

The authors described a fluoroscopic method of guiding percutaneous needle penetration of the foramen ovale. The advantages are simplicity, speed, accuracy, and comfortable patient positioning. Radiation exposure is minimized.

Sixty patients with essential trigeminal neuralgia underwent selective percutaneous thermocoagulation of the gasserian ganglion. Immediate and long-term modifications of pain and tactile facila sensitivity, recurrences of pain, and occurrences of facial paresthesias were evaluated. Pin-prick and von Frey hair tests and somatosensory-evoked potentials were used to study facila sensitivity. Patients with mild alterations of sensitivity-treated with low temperatures of coagulation (60 degrees-70 degrees C)--had a lower incidence of paresthesias, although a higher risk of recurrence. Patients with severe alterations of sensitivity--a consequence of a temperature of coagulation above 70 degrees C--had a high incidence of paresthesias and a low risk of recurrence. In our opinion, the first kind of results are better.

The results of thermo-coagulation have been evaluated in a series of 50 patients followed up from two to six years (average three years). Neuralgia disappeared in nearly 80 p. 100 of the cases (however this was obtained with a second operation in nine cases). The frequency of recurrences increase with time: 20 p. 100 during the first two years reaching 40 p. 100 after three years. They were more likely to occur if the post-operative sensory deficit is moderate. Complications directly related to the surgical technique were rare: some faded away relatively quickly (oculo-motor palsies less than 1 p. 100, masseter weakness 20 p. 100 in the first weeks). The only residual problems were related to sensory deficits: in general they were limited to a small cutaneous area and total anesthesia was never been observed. Although paresthesias were noted in 12 p. 100 of the cases, these usually were not really troublesome. Our conclusion, therefore, is that differential thermocoagulation appears to be the best surgical treatment for trigeminal neuralgia.

The trigeminal ganglion was activated, in humans by thermocoagulation as part of the treatment of trigeminal neuralgia and in cats by electrical stimulation, and blood samples were taken from the external jugular vein for estimates of plasma levels of substance P and calcitonin gene-related peptide (CGRP). In those patients who were noted at the time of coagulation to have flushed there were marked elevations of the local (cranial) levels of both peptides. However, in the nonflushing patients no changes in the peptide levels were observed. Parallel experiments in the cat revealed that the levels of substance P-like and CGRP-like immunoreactivity were increased during electrical stimulation of the trigeminal ganglion. The observation of elevation of substance P-like and CGRP-like immunoreactivity after activation of the nociceptive afferent system of the head provides new insights into a putative role of peptides in the pathophysiology of migraine and cluster headache, and suggests new areas of possible therapeutic intervention.

Sweet's method for thermocoagulation of the Gasserian ganglion is a real advance in the operative treatment of trigeminal neuralgia. The advantages of this method are obvious: minimum operation risk, minimum complication rate, short postoperative convalescence, shorter confinement to hospital and finally the possibility of repeating the operation without risk in the event of a relapse.

325 cases of trigeminal neuralgia were treated by percutaneous semilunar ganglion radiofrequency thermocoagulation from March 1982 to March 1985. All patients were followed-up for more than one year. The effective rate was 98% and the recurrence rate was 20%. 46 recurred cases were successfully treated by reoperation. There were no severe complications and mortality. In this article, the operative method, advantages and prevention of complication are discussed.

The authors discuss on technique and results of percutaneous microcompression of the trigeminal ganglion in patients complaining trigeminal neuralgia.

The authors report the late results of thermocoagulation of the gasserian ganglion in 939 patients operated by 3 different neurosurgical teams, (Bologna, Bordeaux, Marseille). It has been assessed that the results are comparable among the 3 teams and that percutaneous selective thermocoagulation represents a simple and low-risk technique with a high rate of efficacity.

Changes of individual non-esterified fatty acids in serum were studied in 7 metabolically healthy patients, suffering from idiopathic trigeminal neuralgia, who underwent electrocoagulation of gasserian ganglion under neurolepthypalgesia. The mean concentration of fatty acids increased by about 40% during the strong surgical pain stimulus. The increased lipolysis affected all individual fatty acids in proportion to the ratio of their presence in adipose tissue. The mechanism of pain-induced activation of lipase and possible consequences of alterations in individual non-esterified fatty acids are discussed.

Indications, technical procedures, and complications are discussed for the performance of thermal electrocoagulation of the trigeminal preganglionic rootlets and gasserian ganglion. Specific steps in preoperative evaluation, premedication, anesthetic management, and technical performance of graded lesion-making utilizing radiographic control, physiologic stimulation and intraoperative patient monitoring are discussed. A survey of complications is presented.

It has been hypothesized that the trigeminal system may control vasomotor changes and pain in vascular headaches. In this study, headache was induced by an intravenous injection of histamine in 37 patients with trigeminal rhizotomy and in 12 controls. The vasomotor response to histamine was studied with facial telethermography. The headache in patients with trigeminal lesions differed, in a prevalence of unilateral localization contralaterally to the operated side (21 patients), from that in controls. No relationship was found between the hypoesthesia caused by the operation and the prevalence of unilateral headache. A statistically significant correlation (p less than 0.001) was found between unilateral absence of headache and decreased vasomotor response on the operated side. These reactions occurred more in patients who underwent thermocoagulation than in patients who underwent retro-gasserian rhizotomy. Thus the gasserian ganglion seems to control the cranio-facial vasomotor response and the headache through a vascular pathway, acting on cerebral arteries, which differs from the sensory pathway.

From 1976 to 1986, 681 patients with drug-refractory trigeminal neuralgia (TN)--typical in 641, symptomatic of multiple sclerosis in 23 and of tumor in 10, atypical in 5, and postherpetic in 2--were treated with various percutaneous procedures. Controlled differential thermocoagulation of the gasserian ganglion and/or retrogasserian rootlets was performed in 533 patients; glycerolization of the trigeminal cistern in 32; and compression of the gasserian ganglion by balloon catheter in 159. Results and complications of each procedure are assessed at a mean follow-up of 6.5 years for thermocoagulation, 5 years for glycerolization, and 3.5 years for compression. The following therapeutic protocol is proposed: 1) in TN patients at first operation: a) gasserian compression (or glycerolization, if experience warrants it) is indicated in all cases of typical TN, unless the 3rd division alone is affected; b) in the latter case and in symptomatic TN, we suggest thermocoagulation; 2) in recurrences: a) after glycerolization or gasserian compression, gasserian compression (or glycerolization) is indicated; b) after thermocoagulation or open surgery, thermocoagulation is suggested.

Percutaneous radiofrequency lesion of the Gasserian ganglion was performed between 1974 and 1984 in ninety-eight patients for the relief of trigeminal neuralgia. The average follow-up period was 4.5 years. Age, sex, and duration of illness were unrelated to outcome. Satisfactory analgesia was achieved in 68 patients. Thirty-one percent had return of pain (30 cases). Recurrent neuralgia occurred most frequently during first postoperative year (46%). Patients with marked sensory deficits had a reduced risk of recurrence. Postoperative complications included: reduced or absent corneal reflex (18 cases), corneal keratitis (3 cases) and anesthesia dolorosa (2 cases).