Different tunneling techniques for Gasserian ganglion stimulation—a retrospective cohort study

Aim: Gasserian ganglion (GG) percutaneous neurostimulation is a key resource in treating chronic refractory facial pain. However, this procedure has complications, and the literature does not yet document a gold standard for tunneling techniques. The main objective of this study was to compare two different tunneling techniques for GG stimulation and report whether there were associations between the type and rate of complications. Methods: This was a retrospective analysis of medical records of all patients with refractory facial pain, who underwent GG stimulation between January 2010 and June 2022. From 2010 to 2015, the percutaneous GG stimulation procedure was performed with a tunneling technique which involved passing through the preauricular region. Since 2016, this procedure has been performed with a tunneling technique that involved passing directly into the patient’s neck. Results: GG stimulation for refractory facial pain was performed in 49 patients. One of them was implanted twice because of bilateral trigeminal neuropathy. The ear tunneling technique was used for 20 GG stimulation procedures while the tunneling technique involving direct passage of the lead into the neck was used for 30 procedures. The comparison of these two different tunneling techniques showed no statistically significant difference in terms of complications incurred (Fisher exact test, p = 0.451). In the group of patients with ear tunneling, erosion and fibrosis of the neck skin occurred in 20% of cases. This type of complication is not present in patients in whom the other tunneling technique was used. Conclusions: Both tunneling techniques were found to be safe, but the direct technique does not cause fibrosis and erosion of the neck tissues as a complication.