2020 FSA Posters

P055: NAVIGATING MECKEL'S CAVE: CASE REPORT OF GASSERION CISTERN RADIOFREQUENCY ABLATION FOR TREATMENT OF TRIGEMINAL NEURALGIA
Jeff Pence, DO; Kumar Sanjeev, MD; University of Florida Anesthesia Department

Introduction: Trigeminal neuralgia has a prevalence of 4.3 per 100,000 and is the most common cause of facial pain.1 First line therapy for these patients include pharmacotherapy, but when that fails patients require more invasive procedures in order to manage their pain. We present a case of a 24 year old male who received 100% pain relief for greater than one year from a right gasserion cistern radiofrequency ablation (RFA) and discuss the anatomy and approach of reaching the gasserion cistern safely.

Case: The patient is a 24 year old male with past medical history of hypertension, end stage renal disease, and right facial pain secondary to trigeminal neuraglia who presented for atypical right facial pain after wisdom tooth extraction. Diagnosed with trigeminal neuralgia along V2/V3 distribution. At his initial consultation he rated his pain 9/10 on average and stated it was refractory to numerous pharmacotherapy trials. He underwent RFA via passage of 22-gauge 10 cm radiofrequency cannula through the foramen ovale to the level of the spheno-clival line with CSF coming from the cannula. Following the procedure he reported 100% pain relief for great than on year with minimal medication use.

Discussion: Meckel’s cave is near sensitive anatomy such as the internal carotid artery and cavernous sinus. Situated along the anterior inferior lateral wall of the cave is the gasserion ganglion with is adherent to the dura of the cave. Only the posteromedial portion of the ganglion lies in the cistern.2 Being able to navigate this anatomy with the use of fluoroscopic imaging can yield great results for patients that suffer from a difficult to treat chronic pain syndrome.

References:

Bergstralh E., Kurland LT. Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984. Ann Neurol. 1990. January; 27 1: 89-95.

Chui M, Tucker W, Hudson A, Bayer N. High resolution CT of Meckel’s cave. Neuroradiology 1985;27:403-409.