Gasserian ganglion injected with Adriamycin successfully relieves intractable trigeminal nerve postherpetic neuralgia for an elderly patient

Abstract

RationaleEffective treatments for trigeminal nerve postherpetic neuralgia (PHN) are limited. Adriamycin (doxorubicin) has been applied to the treatment of neuropathic pain. This study reports a new treatment: Adriamycin injected to Gasserian ganglion for an elderly patient with the intractable trigeminal nerve PHN.Patient concernsA 75-year-old man complained of lancing, burning pain in the right mandibular branch of the trigeminal nerve (V3) for 3 months after rash eruption.DiagnosesTrigeminal nerve PHN.InterventionsApproximately 0.5 mL of 0.25% Adriamycin and 20 mg methylprednisolone injected to Gasserian ganglion through the foramen ovale with computer tomography guidance.OutcomesThe visual analog scale was 10 of 100 throughout the 1-month follow-up, and oxcarbazepine had also been tapered. The patient remained free of pain at the 12-month follow-up.LessonsThe treatment of Adriamycin injection to Gasserian ganglion is effective and safe, and may be considered as an alternative treatment for trigeminal nerve PHN. However, more research is needed to verify the validity.

Chinese expert consensus on minimally invasive interventional treatment of trigeminal neuralgia

“…Among them, the effect of glycerol on the semilunar ganglion and trigeminal nerve pool is supported by domestic and foreign literature (2b evidence level, B level recommendation) ( Chen et al, 2010 ; Asplund et al, 2016 ; Staudt et al, 2020 ). Anhydrous alcohol can be used for the semilunar ganglion and peripheral division (2b evidence level, B level recommendation) ( Han and Kim, 2010 ; Han et al, 2017 ), and botulinum toxin A (1a evidence level, A level recommendation) ( Morra et al, 2016 ; Steinberg, 2018 ; Yang et al, 2018 ) and doxorubicin are only used in the peripheral branches ( Wang et al, 2011 ; Zheng et al, 2018 ); these drugs have a damaging effect on the surrounding tissues, and their range of action is not easy to control, which may cause serious injuries. At present, with the popularization and application of technologies such as radio frequency and microballoon compression, the use of chemical damage has become increasingly less common ( Udupi et al, 2012 ; Asplund et al, 2016 ; Noorani et al, 2016 , 2019 ), and it is only used at the grassroots level or on specific occasions.…”

A bibliometric and visualization analysis of global research on postherpetic neuralgia from 2000 to 2022: A review

“…[2] According to reports, around 75% of senior patients who contract HZ are likely to experience it. [3] The incidence of it was observed to be 38.1%, 27.0%, and 19.0% at 1 month, 3 months, and 6 months, respectively, following the onset of zoster. It is noteworthy that the incidence of PHN seems to be on the rise.…”