1. Trigeminal (Gasserian) Ganglion Block
Dr. S. Parthasarathy
MD., DA., DNB, MD (Acu), Dip. Diab. DCA, Dip. Software statistics
PhD (physio)
Mahatma Gandhi medical college and research institute – puducherry, India

2. Indications Diagnostic for facial neuralgia
Anaesthesia of surgery of the face
Patients with severe underlying cardiopulmonary disease who require more than minor facial surgery
1 to 3 mL of local anesthetic

3. Anatomy
The trigeminal ganglion is located intracranially and measures 1 × 2 cm.
In its intracranial location, it lies lateral to the internal carotid artery and cavernous sinus and slightly posterior and superior to the foramen ovale, through which the mandibular nerve leaves the cranium

4. Anatomy- three divisions

5. Anatomy
The trigeminal ganglion is partially contained within a reflection of dura mater, Meckel's cave.
Three divisions
Sensory , sensory, and partially motor

6. Position supine position Fixed gaze straight
Anaesth . Stands by the side
Clench teeth
Identify medial border of masseter
3 cm lateral to corner of the mouth
Sluijter-Mehta-Kanula cannula, 10 cm 22 G with a 2 mm active tip.

7. Technique Plane of zygoma and mandibular arch 10-cm needle is inserted
Plane of pupil
Aided by fluoroscopy
sphenoid bone
4.5 – 6 cm
Foramen ovale -6-7

8. Technique

9. technique

10. Fluoro

11. Another fluoro image

12. Technique Mandibular paresthesia- insufficient
Some more insertion – elicit paresthesia in maxillary or ophthalmic area
Aspirate - CSF – nil – 1 ml then wait for 5 minutes then give 1 ml
No CSF
40 mg methylprednisolone, 4 mg dexamethasone, or 40 mg triamcinolone acetate – addition

13. TIPS
Initially, the needle is directed downward and laterally. Then, the needle is aimed medially for the foramen ovale to avoid mouth entry.
One finger should be placed in the mouth to prevent intraoral entry of the needle.
Prophylactic antibiotics and sedation with midazolam and fentanyl are advised.
2-3 ml syringe

14. Radiofrequency
generation of a pulsed electromagnetic field radiofrequency at 42°C for a 120-second cycle times two to three cycles.
Standard radiofrequency neurolysis can also be performed at 67°C for 90 seconds. associated with a risk of sensory loss in the trigeminal nerve distribution.

15. Other techniques compression using a Fogarty-type balloon.
More recently, surgical microvascular
decompression and gamma knife irradiation of the nerve have been introduced.

16. Other drugs
Alcohol
Glycerol
6 % phenol
With or without omnipaque
Cryo

17. Complications
CSF
Vascular injury
Painful procedure
No time pressure

18. Other described complications
Masticator muscle weakness,
corneal analgesia,
seizure, coma, keratitis, bacterial meningitis, carotid fistula, intracranial hemorrhage, diplopia, death, and facial or subscleral hematoma.

19. Thank you all
The agony of pain is gone and the patient will smile like