Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); gasserian ganglion
CPT4 code
Name of the Procedure:
Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (e.g., alcohol, thermal, electrical, radiofrequency); gasserian ganglion
Common name(s): Stereotactic Gasserian Ganglion Neurolysis, Trigeminal Nerve Lesioning
Summary
This procedure involves creating a targeted lesion on the gasserian ganglion, a key nerve cluster related to facial sensation. By using a neurolytic agent (such as alcohol, thermal, electrical, or radiofrequency energy) and a stereotactic method, which is a precise, image-guided technique, pain relief can be obtained for conditions like trigeminal neuralgia.
Purpose
The procedure is designed to alleviate severe facial pain associated with trigeminal neuralgia. The goal is to disrupt nerve pathways that are sending pain signals, thereby providing the patient with significant pain relief.
Indications
- Severe, chronic facial pain due to trigeminal neuralgia
- Failure of conservative treatments such as medication
- Intractable pain not responding to other less invasive interventions
Preparation
- Fasting for at least 8 hours prior to the procedure
- Review and modification of current medications by the doctor
- Imaging studies such as MRI or CT scans to plan the procedure
Procedure Description
- The patient is positioned and local anesthesia is administered.
- A stereotactic frame is used to precisely guide the placement of a needle to the gasserian ganglion.
- Using real-time imaging (such as fluoroscopy), the healthcare provider advances the needle to the target area.
- Once the needle is in place, the neurolytic agent (e.g., alcohol, radiofrequency energy) is administered to create a lesion.
- The needle is then withdrawn, and the procedure site is cleaned and dressed.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
Performed in a hospital or outpatient surgical center with appropriate imaging and monitoring facilities.
Personnel
- Neurosurgeon or Interventional Pain Specialist
- Radiologic Technologist
- Nursing staff
- Anesthesiologist (if general anesthesia or sedation is used)
Risks and Complications
- Pain at the injection site
- Infection
- Bleeding
- Nerve damage leading to numbness or loss of facial sensation
- Double vision or difficulty swallowing (rare)
- Transient side effects such as facial bruising or weakness
Benefits
- Significant reduction or complete relief from facial pain
- Improvement in quality of life
- Benefits are often noticed within days to a few weeks post-procedure
Recovery
- Minimal downtime, with most patients able to return home the same day
- Possible mild swelling or tenderness at the injection site
- Likely required follow-up visits to monitor progress
- Restrictions on certain activities like heavy lifting for a few days
Alternatives
- Medications (anticonvulsants or antispasmodic drugs)
- Microvascular decompression surgery
- Gamma Knife radiosurgery
- Peripheral nerve blocks
Pros of Alternatives:
- Non-invasive options may have fewer immediate risks.
- Some alternatives can provide long-term relief without lesion creation.
Cons of Alternatives:
- Medications may have side effects and may not always be effective.
- Surgical approaches may involve longer recovery times and different risks.
Patient Experience
During the procedure, the patient may feel pressure or discomfort at the needle insertion site. Post-procedure, there may be temporary pain relief followed by a gradual reduction in facial pain. Pain management strategies, such as prescribed analgesics, and comfort measures like cold packs, can help manage initial post-procedural discomfort.