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Abstract Details

Case Of Percutaneous Trigeminal Ganglion Block With Intraoperative Monitoring Of Blink Reflex For Refractory Trigeminal Neuralgia.
Headache
Headache Posters (7:00 AM-5:00 PM)
105

Several surgical options are available including trigeminal ganglion block, radiofrequency thermocoagulation and microvascular decompression. Electrophysiological monitoring of blink reflex can be used to identify the branches of the trigeminal nerve while performing trigeminal ganglion block.

To describe a case of successful percutaneous trigeminal ganglion block guided by electrophysiological monitoring of blink reflex for treatment of refractory trigeminal neuralgia

Case report

A 39-year-old woman was diagnosed with refractory trigeminal neuralgia (pain score 9/10 on visual analog scale) having failed multiple medications including carbamazepine, gabapentin, valproate, lamotrigine and baclofen. She then underwent percutaneous trigeminal ganglion blockade with electrophysiological monitoring of blink reflex. The needle was advanced along medial aspect of mandible and zygomatic arch under fluoroscopy into the foramen ovale. Serial assessment of blink reflex was performed by placing the lead on right lower lateral orbicularis oculi muscle with reference electrode along lateral surface of the nose. A total of 20mg 1% lidocaine was injected with corresponding slowing of the blink reflex noted on EMG. Then, 104mg (in 7.8ml) liposomal bupivacaine was injected with complete abolishment of blink reflex noted at the end of injection. Patient then reported having right face anesthesia. Dyna CT head post injection showed the needle in foramen ovale. Patient reported no recurrence of pain one month post procedure.

Refractory trigeminal neuralgia can be treated successfully by percutaneous trigeminal blockade guided by electrophysiological monitoring of blink reflex. Electrophysiological monitoring of blink reflex can be helpful in localizing the branches of trigeminal nerve and suppression response can be used objectively for quantitating the magnitude of trigeminal blockade.

Authors/Disclosures
Sachin M. Bhagavan, MD (University of Missouri- Health Care)
PRESENTER
Dr. Bhagavan has nothing to disclose.
Swathi Beladakere Ramaswamy, MD (University of Missouri Healthcare, Dept of Neurology) Dr. Beladakere Ramaswamy has nothing to disclose.
Tejas R. Mehta, MD (University of Missouri, Columbia) Dr. Mehta has nothing to disclose.
Nitish Kumar, MD (Baptsit Health South) Dr. Kumar has nothing to disclose.
Tariq Hamid, MD (UF College of Medicine-Jacksonville) Dr. Hamid has nothing to disclose.
Muhammad Fawad Ishfaq, MD Dr. Ishfaq has nothing to disclose.
Camilo Ramiro Gomez, MD, FAAN (University of Missouri) Dr. Gomez has nothing to disclose.
Farhan *use130785 Siddiq Farhan Siddiq has nothing to disclose.
Raghav Govindarajan, MD, FAAN (HSHS St. Elizabeth Medical Group) Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MT pharma. Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Catalyst. Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche . Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sarepta. Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amicus. Dr. Govindarajan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion. Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for MT pharma . Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Catalyst. The institution of Dr. Govindarajan has received research support from Band of Hope . The institution of Dr. Govindarajan has received research support from Alexion. Dr. Govindarajan has received publishing royalties from a publication relating to health care.
Adnan I. Qureshi, MD (Dept of Neurology) Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.