Trigeminal lymphadenectomy (GASSER) by absolute alcohol injection

Posted by Master, Resident Doctor Tran Duc Tuan - Department of Diagnostic Imaging - Vinmec Central Park International General Hospital

The technique of destroying the trigeminal ganglion (Gasser) by absolute alcohol injection is used in the treatment of nerve pain V for quick results, this method is often applied to patients with poor health, chronic diseases that cannot be operated on or do not agree to surgery.

Nerve pain is a pain condition that occurs in one or more areas of the sensory nerve of the V. The pain is sudden, usually unilateral, sharp, short, pain sensation. throbbing like an electric shock, or recurring intermittently.
Currently, there are many methods of treatment for V nerve pain. Gasser lymph node dissection is a method often applied to patients with poor health, severe chronic diseases that cannot be operated on, or do not agree to surgery.

Indicated in the following cases:
Patients who have failed treatment with drugs Patients with age, or chronic medical diseases whose health does not guarantee anesthesia Patients with pain again after surgery Repeat many times on the same method Methods Available at the facility and explained to the patient Contraindications:
Absolute Contraindication: No absolute contraindication to alcohol desensitization Relative Contraindication: Patients with renal impairment Severe heart failure, severe renal failure, severe coagulopathy, severe respiratory dysfunction, etc. Depending on the specific case, the clinician or the procedure physician will decide whether to perform the procedure. or not.

The doctor conducts the intervention with the help of nurses and technicians:
Step 1: Prepare the patient
The patient lies on his back, with his shoulders slightly elevated for the head to tilt back about 15-20 degrees but not Rotate Set the machines to monitor blood pressure, electrocardiogram, heart rate activity during the intervention Place the intravenous line: Infuse Ringer lactate solution slowly to keep the line Step 2: Carry out the intervention
Disinfection of the intervention marker area Locating the oval hole on the light screen Inserting the needle into the space around the Gasser ganglion: Percutaneous needle puncture position: Located on the horizontal line of the corner of the mouth, about 2-2.5cm from the outer corner of the mouth Needle direction From the percutaneous position to the foramen ovale Before the needle puncture, the percutaneous needle site should be anesthetized with 1% Lidocaine with a dose of 1ml. Conduct needle puncture combined with observation on the projection screen to orient the needle into the oval hole. Once the needle has passed through the oval hole, proceed to rotate the slant ball to reposition the needle tip. Continue to observe on the screen and adjust the needle tip so that the position of the needle tip is between the upper and lower edges of the stony bone. When the needle tip is in the position of the Gasser ganglion fossa, inject 0.3-1ml of Ominipaque 300mg/50ml undiluted contrast agent through the needle under background erasure mode to locate the needle tip Absolute alcohol injection: After confirming Accurately determine the position of the needle tip and check that there is no leakage of contrast, then we can inject absolute alcohol. Inject slowly for about 15-20 seconds, averaging about 0.3ml of absolute alcohol. Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in medical examination and treatment, patients can rest assured to visit. and hospital treatment.

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