Efficacy and Safety of CT-guided Ozone Neurolysis of the Gasserian Ganglion for Idiopathic Trigeminal Neuralgia in Elderly Patients (≥70 Years Old) – A Retrospective Observational Cohort Study

Objective: To retrospectively analyze the long-term efficacy, safety, and durability of CT-guided ozone neurolysis of the Gasserian Ganglion in elderly patients (≥70 years old) with Idiopathic Trigeminal Neuralgia (ITN). Methods: This was a retrospective, single-center, observational cohort study. Consecutive elderly patients with ITN meeting the inclusion criteria between January 2020 and December 2022 were enrolled. All patients underwent percutaneous puncture of the foramen ovale under CT guidance, followed by injection of 5 mL of a medical-grade ozone-oxygen mixture (concentration: 30 µg/mL) around the Gasserian Ganglion. The primary efficacy endpoint was the change in pain intensity assessed using the Visual Analog Scale (VAS). Secondary endpoints included the Barrow Neurological Institute (BNI) pain intensity score, pain recurrence rate, and patient satisfaction. All perioperative and postoperative complications were systematically recorded. All patients completed a 24-month follow-up period. Results: A total of 85 patients (mean age 76.54.2 years) were included. The mean VAS score significantly decreased from 8.20.9 at baseline to 2.11.5 at 24 months (P<0.001). At the final 24-month follow-up, 69 patients (81.2%) achieved satisfactory pain control (BNI grades I-III), among whom 55 patients (64.7%) were completely pain-free without medication (BNI grade I). Kaplan-Meier survival analysis estimated the recurrence-free survival rates at 12 and 24 months postoperatively to be 85.3% and 78.5%, respectively. The most common complication was transient facial hypesthesia (10 cases, 11.8%), which resolved spontaneously within 24 hours in all instances. No instances of anesthesia dolorosa, keratitis, intracranial hemorrhage, or other serious, permanent complications occurred. Conclusion: CT-guided ozone neurolysis of the Gasserian Ganglion is a safe, effective, and durable minimally invasive method for treating elderly patients with ITN. Its non-neurodestructive nature, excellent safety profile, and repeatability offer a highly valuable therapeutic option for this special patient population, who often have multiple comorbidities and are poor candidates for traditional craniotomy or neuroablative procedures.

References
[1] Levin, M. (2025) International Classification of headache disorders and diagnosis of migraine and its subtypes. Comprehensive Review of Headache Medicine, 101.
[2] Bendtsen, L., Zakrzewska, J. M., Heinskou, T. B., Hodaie, M., Leal, P. R. L., Nurmikko, T., Oberman, M., Cruccu, P. G., Maarbjerg, S. (2020) Advances in diagnosis, classification, pathophysiology, and management of Trigeminal Neuralgia. The Lancet Neurology, 19(9), 784-796.
[3] Latorre, G., González-García, N., García-Ull, J., González-Oria, C., Porta-Etessam, J., Molina, F. J., Guerrero-Peral, A. L., Belvís, R., Rodríguez, R., Bescós, A., Irimia, P., Santos-Lasaosa, S. (2023) Diagnosis and treatment of Trigeminal Neuralgia: consensus statement from the Spanish Society of Neurology’s Headache Study Group. Neurología (English Edition), 38, S37-S52.
[4] Melek, L. N., Devine, M., Renton, T. (2018) The psychosocial impact of orofacial pain in Trigeminal Neuralgia patients: a systematic review. International Journal of Oral and Maxillofacial Surgery, 47(7), 869-878.
[5] Venda Nova, C., Zakrzewska, J. M., R. Baker, S., Ni Riordain, R. (2021) Patient reported outcome measures in Trigeminal Neuralgia – a systematic review of psychometric perfor-mance. European Journal of Pain, 25(7), 1449-1461.
[6] Ruscheweyh, R., Gierthmühlen, J., Hedderich, D. M., Goßrau, G., Leis, S. (2024) Medikamentöse therapie der Trigemin-usneuralgie. Der Schmerz, 38(4), 283-292.
[7] Gambeta, E., Chichorro, J. G., Zamponi, G. W. (2020) Trigeminal Neuralgia: an overview from pathophysiology to pharmacological treatments. Molecular Pain, 16, 1744806920901890.
[8] Yang, F., Lin, Q., Dong, L., Gao, X., Zhang, S. E. (2018) Efficacy of 8 different drug treatments for patients with Trigeminal Neuralgia: a network meta-analysis. The Clinical Journal of Pain, 34(7), 685-690.
[9] Greve, T., Tonn, J. C., Mehrkens, J. H. (2021) Microvascular decompression for Trigeminal Neuralgia in the elderly: efficacy and safety. Journal of Neurology, 268(2), 532-540.
[10] Phan, K., Rao, P. J., Dexter, M. (2016) Microvascular decompression for elderly patients with Trigeminal Neuralgia. Journal of Clinical Neuroscience, 29, 7-14.
[11] Wu, Z., Zhao, Y., Liu, J., Fan, Y., Yang, Y. (2023) Comparison of the safety and efficacy of radiofrequency thermocoagulation with percutaneous balloon compression for treating Trigeminal Neuralgia: a systematic review and meta-analysis. Frontiers in Neurology, 14, 1178335.
[12] Li, Y., Yang, L., Ni, J., Dou, Z. (2019) Microvascular decompression and radio-frequency for the treatment of Trigeminal Neuralgia: a meta-analysis. Journal of Pain Research, 1937-1945.
[13] Fan, X., Xu, F., Ren, H., Lu, Z., Bu, H., Ma, L., Kong, C., Wang, T. (2021) The analysis of percutaneous balloon compression on efficacy and negative emotion in the treatment of recurrent Trigeminal Neuralgia after surgical procedures. Pain Physician, 24(8), E1255.
[14] Hidalgo-Tallón, F. J., Torres-Morera, L. M., Baeza-Noci, J., Carrillo-Izquierdo, M. D., Pinto-Bonilla, R. (2022) Updated review on ozone therapy in pain medicine. Frontiers in Physiology, 13, 840623.
[15] Eldemrdash, A., Tairy, T., Sabry, L., Aelmulla, A., Kamel, M., Yousry, E. (2024) Efficacy of medical ozone for treatment of chronic musculoskeletal pain with abnormal mitochondrial redox state: prospective randomized clinical trial. Pain Physician, 27(4), E371.
[16] de Andrade, R. R., de Oliveira-Neto, O. B., Barbosa, L. T., Santos, I. O., de Sousa-Rodrigues, C. F., Barbosa, F. T. (2019) Effectiveness of ozone therapy compared to other therapies for low back pain: a systematic review with meta-analysis of randomized clinical trials. Brazilian Journal of Anesthesiology (English Edition), 69(5), 493-501.
[17] An, J. X., Liu, H., Chen, R. W., Wang, Y., Zhao, W. X., Eastwood, D., Williams, J. P. (2018) Computed tomography-guided percutaneous ozone injection of the Gasserian Ganglion for the treatment of Trigeminal Neuralgia. Journal of Pain Research, 255-263.
[18] Gao, L., Chen, R. W., Williams, J. P., Li, T., Han, W. J., Zhao, Q. N., Wang, Y., An, J. X. (2020) Efficacy and safety of percutaneous ozone injection around Gasserian Ganglion for the treatment of Trigeminal Neuralgia: a multicenter retrospective study. Journal of Pain Research, 927-936.
[19] Delgado, D. A., Lambert, B. S., Boutris, N., McCulloch, P. C., Robbins, A. B., Moreno, M. R., Harris, J. D. (2018) Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. JAAOS Global Research & Reviews, 2(3), e088.
[20] Malloy, S., Genova, H., Chiaravalloti, N., DeLuca, J., Holtzheimer, P., Wylie, G. R. (2021) Cognitive fatigue in traumatic brain injury: a pilot study comparing state and trait fatigue. Brain Injury, 35(10), 1254-1258.
[21] Jain, A. (2019) Comparative analysis of balloon compression and radiofrequency ablation in Idiopathic Trigeminal Neuralgia: a retrospective study with a 24-month follow-up. Turkish Journal of Anaesthesiology and Reanimation, 47(2), 146.
[22] Zheng, S., Yuan, R., Ni, J., Liu, H., Yang, Y., Zhang, S., Li, J. (2022) Long‐term recurrence‐free survival and complications of percutaneous balloon compression and radiofrequency thermocoagulation of Gasserian Ganglion for Trigeminal Neuralgia: a retrospective study of 1313 cases. Pain Practice, 22(5), 532-540.
[23] Huang, P., Liu, H., Liu, Z., Huang, L., Lu, M., Wang, L., Yu, Y., Jin, X. (2023) Effectiveness of percutaneous balloon compression (PBC) in improving physical function and quality of life in Trigeminal Neuralgia: a retrospective study. Acta Neurochirurgica, 165(12), 3905-3912.
[24] Xu, R., Xie, M. E., Jackson, C. M. (2021) Trigeminal Neuralgia: current approaches and emerging interventions. Journal of Pain Research, 3437-3463.
[25] Jafree, D. J., Zakrzewska, J. M. (2019) Long-term pain relief at five years after medical, repeat surgical procedures or no management for recurrence of Trigeminal Neuralgia after microvascular decompression: analysis of a historical cohort. British Journal of Neurosurgery, 33(1), 31-36.
[26] Zheng, J. H., Sun, K., Zhang, H. T., Xie, Y. J., Wang-Yang, L. X., Chen, H. Y., Wang, C. (2020) A study on the recurrence rate of Trigeminal Neuralgia after MVD and the related factors. Journal of Neurological Surgery Part B: Skull Base, 81(05), 572-578.

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Yang, M., Qiong, X., Yang, H., Xu, X., Yang, H., Al-Goshae, H. A. A. (2025) Efficacy and Safety of CT-guided Ozone Neurolysis of the Gasserian Ganglion for Idiopathic Trigeminal Neuralgia in Elderly Patients (≥70 Years Old) – A Retrospective Observational Cohort Study. Journal of Disease and Public Health, 1(2), 64-74. https://doi.org/10.71052/jdph/WILP5367