Computed tomography-guided percutaneous ozone injection of the Gasserian ganglion for the treatment of trigeminal neuralgia

Abstract

ObjectiveThe aim of this study was to evaluate the therapeutic effect of computed tomography (CT)-guided percutaneous ozone injection for refractory trigeminal neuralgia.DesignA retrospective evaluation was performed in the study.SettingThe study was conducted at a university hospital pain center.Patients and methodsA total of 29 patients with a clinical diagnosis of refractory trigeminal neuralgia were enrolled. All patients were treated with a percutaneous ozone injection and one patient was excluded. There were 21 patients with classical trigeminal neuralgia (group A) and seven patients with painful trigeminal neuropathy caused by post-herpetic neuralgia (group B). The percutaneous injection was an oxygen–ozone mixture at an ozone concentration of 30 μg/mL into the Gasserian ganglion performed under CT guidance. The number of procedures performed varied from one to as many as 16. Outcomes were evaluated using visual analog scale (VAS) pain scores.ResultsThe combined VAS scores were 7.11 ± 1.23 pretreatment, 2.86 ± 1.69 posttreatment (P < 0.05) and 3.25 ± 2.01 after 6-month follow-up (P < 0.05). In group A, the VAS scores were 7.10 ± 1.04 pretreatment and 2.90 ± 1.84 posttreatment (P < 0.05). In group B, the VAS scores were 7.14 ± 1.77 pretreatment and 2.71 ± 1.25 posttreatment (P < 0.05). After 6-months follow-up, the VAS score was 3.38 ± 2.18 in group A and 2.86 ± 1.46 in group B, a decrease compared to pretreatment (P < 0.05). VAS of Group A and B showed no difference not only in pretreatment but also in postreatment and follow-up.ConclusionPercutaneous ozone injection is a safe and effective treatment for patients with refractory trigeminal neuralgia.

The effect of ultrasound-guided percutaneous ozone injection around cervical dorsal root ganglion in zoster-associated pain: a retrospective study

“… 1 There is an increase of chemical mediators from the injured tissue, including cytokines, substance P, histamine, etc. 3 , 11 These changes also increase the ectopic discharge rate of C-fiber nociceptors. Repetitive discharge of C-fibers can lead to a prolonged response of neurons in the DRG, that may contribute to chronic pain states or PHN.…”

“…Ozone therapy has been used to treat several diseases such as herniated discs, trigeminal neuralgia and refractory headache. 11 , 19 – 21 An anti-inflammatory action induced by ozone has been reported and ozone notably increases the release of neutralizing pro-inflammatory cytokines such as interleukin IL-2, IL-8, IL-15, interferon-α and tumor necrosis factor-α. 32 , 33 Steroids are also used to treat the ZAP patients; however, it may not only increase the risk of infection but also, is not an ideal option for the diabetic patient.…”

“…It has been considered that chronic pain is mainly related to chronic inflammation, 22 and the analgesia of ozone might be correlated to the anti-inflammation properties. 11 Other probable mechanisms of ozone-induced pain relief could be activating the descending antinociceptive system and increasing the release of endorphins. 22 The efficacy of standard treatments combined with the unique capacity of ozone therapy to reactivate the innate antioxidant system is the key to correcting the oxidative stress typical of chronic inflammatory diseases.…”

“…10 Pulsed radiofrequency treatment (PRF) is also being used for conditions with refractory neuropathic pain such as trigeminal neuralgia, chronic cervical and lumbosacral pain. 11 – 14 Nevertheless, the efficacy of PRF for the reduction of intractable pain is still controversial 15 and PHN often remains intractable to existing treatments despite the many therapeutic options available. 16…”

“…In some previous studies, it has been indicated that percutaneous ozone injection can be an effective treatment for neuropathic symptoms without causing tissue damage within a certain concentration range (below 70 µg/mL). 18 And this method is also one of several minimally invasive therapies that have been used for the treatment of chronic neuropathic pain such as herniated discs and trigemi-nal neuralgia 11 , 19 , 20 ; although, the exact mechanism underlying ozone-induced analgesia is not well understood yet. At concentrations around 30 µg/mL, ozone not only could enhance oxygenation and reduce inflammation at the disease site due to the oxidizing effect on pain-producing mediators, but also lead to increased local oxygen supply and reduced nerve root ischemia and edema.…”