Gamma Knife Radiosurgery and Maxillary Nerve Block with Alcohol in the Trigeminal Neuralgia Involving V1 and V2 Divisions

The first line treatment for trigeminal neuralgia (TN) is medical therapy. However, if medical treatments are ineffective or produce intolerable side effects, invasive or ablative treatment modalities are performed. These modalities include ablative procedures such as alcohol neurolysis, percutaneous balloon compression, radiofrequency thermocoagulation, gamma knife radiosurgery (GKRS) and non-ablative microvascular decompression (MVD). The patient presented in this case had been TN involving maxillary division and treated with infraorbital nerve block. And then a new intractable TN occurred in ophthalmic division. We performed GKRS and were able to control the pain involving the ophthalmic division without sensory change. After three months, the TN involving maxillary division became severe, additional maxillary nerve block using alcohol was conducted. We present this case as the pain caused by trigeminal neuralgia involving different divisions were controlled applying GKRS and maxillary nerve block.