Breaking the pain cycle: CT-guided Gasserian ganglion injection as an alternative for trigeminal neuralgia, a case report

Background Trigeminal neuralgia (TN) in elderly or medically complex patients poses significant management challenges due to medication side effects, comorbidities, and limited tolerance for invasive surgery. Cases This case series described two elderly patients with multiple comorbidities and medically refractory TN who underwent CT-guided Gasserian ganglion injection after declining or being unsuitable for microvascular decompression or radiofrequency ablation. Both procedures were performed under CT guidance using 2% lignocaine and 8 mg dexamethasone, with no procedural complications. Patient 1 reported reduced pain intensity and medication reliance, while Patient 2 experienced complete pain relief lasting eight months, requiring a repeat injection with similar benefit. This minimally invasive approach provided meaningful symptom control, improved quality of life, and preserved independence, with a low side effect profile. Although analgesia is often temporary, repeat injections are feasible. Conclusion CT-guided Gasserian ganglion injection appears to be a feasible and potentially effective therapeutic option for elderly patients with TN who are unable to tolerate pharmacological treatment. Nevertheless, the current evidence base remains limited, and well-designed controlled studies are required to more clearly establish its safety and efficacy.