Breaking the pain cycle: CT-guided Gasserian ganglion injection as an alternative for trigeminal neuralgia, a case report

Background: Trigeminal neuralgia (TN) in elderly or medically complex patients poses significant management challenges due to medication side effects, comorbidities, and limited tolerance for invasive surgery. Cases: This case series described two elderly patients with multiple comorbidities and medically refractory TN who underwent CT-guided Gasserian ganglion injection after declining or being unsuitable for microvascular decompression or radiofrequency ablation. Both procedures were performed under CT guidance using 2% lignocaine and 8 mg dexamethasone, with no procedural complications. Patient 1 reported reduced pain intensity and medication reliance, while Patient 2 experienced complete pain relief lasting eight months, requiring a repeat injection with similar benefit. This minimally invasive approach provided meaningful symptom control, improved quality of life, and preserved independence, with a low side effect profile. Although analgesia is often temporary, repeat injections are feasible. Conclusion: CT-guided Gasserian ganglion injection appears to be a feasible and potentially effective therapeutic option for elderly patients with TN who are unable to tolerate pharmacological treatment. Nevertheless, the current evidence base remains limited, and well-designed controlled studies are required to more clearly establish its safety and efficacy.

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