Refractory Trigeminal Neuralgia Treatment with Cryoneurolysis in a Patient with Idiopathic Thrombocytopenic Purpura: A Case Report.

BACKGROUND

Trigeminal neuralgia is a debilitating facial pain condition. Managing trigeminal neuralgia in patients with co-existing conditions like idiopathic thrombocytopenic purpura, which increases bleeding risk, presents a significant clinical challenge, especially when considering interventional procedures.

CASE REPORT: We present the case of a 54-year-old woman with refractory right-sided trigeminal neuralgia and idiopathic thrombocytopenic purpura. Due to her idiopathic thrombocytopenic purpura and a new acute cerebrovascular accident, she was not a candidate for microvascular decompression. Initial gamma knife treatment provided only transient relief. Because of her bleeding risk, less invasive peripheral trigeminal branch blocks were performed, followed by cryoneurolysis of the infraorbital and mental nerves, which provided significant and sustained pain relief for 11 months.

CONCLUSION

This case highlights that for patients with trigeminal neuralgia who have a high bleeding risk due to conditions like idiopathic thrombocytopenic purpura, peripheral trigeminal branch blocks under ultrasound guidance, followed by cryoneurolysis, can be a safe and effective alternative to more invasive procedures, offering long-lasting pain relief.