20 Trigeminal (Gasserian) Ganglion Block
Perspective
Although the trigeminal ganglion block can be used for surgical procedures involving the face, its principal use is as a diagnostic block before trigeminal neurolysis in patients with facial neuralgia. Even after the anesthesiologist successfully identifies the trigeminal nerve as the cause of facial pain, neurolysis is most often carried out today using thermocoagulation techniques rather than neurolytic solutions.
Patient Selection
Current practice patterns virtually guarantee that patients undergoing this block will be experiencing facial neuralgia. Patients with severe underlying cardiopulmonary disease who require more than minor facial surgery may be candidates for local anesthetic trigeminal ganglion blocks.
Placement
Anatomy
The trigeminal ganglion is located intracranially and measures approximately 1 × 2 cm. In its intracranial location, it lies lateral to the internal carotid artery and cavernous sinus and slightly posterior and superior to the foramen ovale, through which the mandibular nerve leaves the cranium (Fig. 20-1). From the trigeminal ganglion, the fifth cranial nerve divides into its three principal divisions: the ophthalmic, maxillary, and mandibular nerves. These nerves provide sensation to the region of the eye and forehead, upper jaw (midface), and lower jaw, respectively (see Fig. 20-1). The mandibular division carries motor fibers to the muscles of mastication, but otherwise these nerves are wholly sensory. The trigeminal ganglion is partially contained within a reflection of dura mater, Meckel’s cave. Figures 20-2 and 20-3
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