Severe resistant trigeminal neuralgia managed successfully by computed tomography-guided gasserian ganglion block

The present case report discussed the management of a 62-year-old female patient with medically refractory trigeminal neuralgia (TN) with percutaneous computed tomography-guided gasserian ganglion block (CT-GGB). Using Hartel anterior approach, we successfully performed CT-GGB with precise positioning of the 22G LP needle tip in the medial aspect of the foramen ovale at the base of the skull as was witnessed clinically by the patient as sharp pain along the affected areas of the face, confirmed by serial CT screening until it reaches the predefined depth. Later, neurolysis mixture was injected, and the needle was finally flushed with 0.5 ml of normal saline and then withdrawn. Sterile dressing was applied at the skin entry site after removing the LP needle. Postprocedural check, CT was performed to look for any immediate complications. Patients were observed for regular follow-up at 1 week, 2 weeks, 1 month, 3 months, and every 3 months after that. The patient was relieved entirely of facial pain on the CT table (Numerical Rating Scale Pain Score-0) with minimal facial numbness and no sensation loss. To conclude, CT-GGB invention is an effective and safe technique for medically refractory TN.