Role of Advanced Imaging in Gasserian Neurolysis in Head and Neck Cancer with Skull Base Invasion

Abstract

Introduction A 46-year-old female with a postoperated case of carcinoma left upper alveolus diagnosed in March 2018, with recurrence, was presented to the hospital. She had lancinating pain around left facial pain, which gradually increased over 10 months. On numerical rating scale, her pain was 9 on 10. Her chief complaint was continuous dull pain above and below the left eye, with sudden, brief, paroxysmal episodes of intolerable burning and stabbing type of pain. This episodic pain lasted for 30 to 40 seconds. On examination, she had left III, V, and VI nerve palsy with ptosis. Magnetic resonance imaging of face and brain revealed an enhancing infiltrative mass in left maxillary sinus extending to base of skull. Clinical diagnosis of left-sided painful trigeminal neuropathy in ophthalmic and maxillary (V1 and V2) division was made. Aim This study was aimed to relieve patient’s pain and improve her quality of life. Materials and Methods Gasserian neurolysis was successfully completed under computed tomography (CT) guidance because of the distortion of skull base anatomy using a 22-G, 10-cm long spinal needle directed towards foramen ovale (FO) from a lateral approach. Conclusion CT-guided identification of foramen ovale can be labeled as a novel method of locating FO for precise percutaneous techniques to the trigeminal ganglion in advanced head and neck cancers.

Keywords

• trigeminal neuropathy
• gasserian neurolysis
• foramen ovale
• glycerol