Facial flushing after thermocoagulation of the Gasserian ganglion.

Abstract

SUMMARY The development of a facial flush during thermocoagulation of the Gasserian ganglion was monitored in 16 patients with pulse recording techniques and in a further 17 patients with thermography. There was a close association between the development of the facial flush in the distribution of one or more divisions of the trigeminal nerve and the subsequent demonstration of postoperative analgesia. In regions where significant changes took place, vascular pulsations increased 25-233% (mean 96%) and facial temperature rose 0*5-2-0°C. The response persisted for up to an hour postoperatively, and was not diminished in patients with pre-operative analgesia from a previous procedure. Possible mechanisms for the facial flush, including stimulation of an active vasodilator system, the antidromic release of vasoactive substances from trigeminal nerve terminals and the release of tonic vasoconstriction are discussed. A practical application of the pulse recording technique used in the present investigation would be to monitor the distribution of vasodilatation at operation to avoid unwanted first division sensory loss.Flushing on one side of the face may follow an attack of trigeminal neuralgia' and has been observed after injection of alcohol into the ipsilateral trigeminal (Gasserian) ganglion.2 Rowbotham2 commented that facial temperature and skin colour did not alter after tractotomy, root section or intracranial neurectomy, and attributed the rise in skin temperature after alcohol injection of the ganglion to involvement of sympathetic fibres either in the ganglion or adjacent to it. Oka3 reported that temperature increased on one or both sides of the face following injection of alcohol into the Gasserian ganglion, the response reaching its peak 10-30 minutes after injection and persisting for 40-120 minutes.Similar

The Red Ear Syndrome: An Auriculo‐Autonomic Cephalgia

“…This mechanism is thought to account for the facial flush seen after stabbing pains of tic douloureux or after thermocoagulation of the trigeminal ganglion, when it is confined to the skin areas innervated by the appropriate division or divisions of the trigeminal nerve 6 . Similar flushing is seen overlying the painful parts of the face in cluster headache and other trigemino‐autonomic cephalgias such as chronic paroxysmal hemicrania.…”

Release of vasoactive peptides in the extracerebral circulation of humans and the cat during activation of the trigeminovascular system

“…Blood was taken from the external jugular vein before, during, and after thermocoagulation and processed for peptide assay. The thermocoagulation procedure is described elsewhere [2). Briefly, a thermistor needle was inserted through the foramen ovale, the tip position being confirmed fluoroscopically.…”

Further characterization of the putative 5‐HT receptor which mediates blockade of neurogenic plasma extravasation in rat dura mater

“…Constriction of extracranial cephalic blood vessels follows ergotamine administration but neurogenic plasma extravasation is not blocked in these tissues. Finally, it would be difficult to conceive how a vasoconstrictor drug action alone would explain the blockade of neuropeptide increases in sagittal sinus, platelet accumulation and mast cell degranulation accompanying trigeminal stimulation has been documented in man (Sweet & Wepsic, 1974;Drummond et al, 1983;Goadsby et al, 1988) and experimental animals (Jancso-Gabor & Szolcsanyi, 1972;Couture & Cuello, 1984;Goadsby et al, 1988). Both neurogenic plasma extravasation and headache can be blocked by aspirin and in selected cases, by indomethacin pretreatment (Buzzi et al, 1989).…”