The trigeminal (Gasserian or semilunar) ganglion is the large crescent-shaped sensory ganglion of the trigeminal nerve. It sits in a pocket of dura called the trigeminal (Meckel) cave near the tip of the petrous temporal bone in the middle cranial fossa. Its front edge gives rise to the ophthalmic, maxillary and mandibular divisions, which carry sensation from most of the face.
| Origin | Cell bodies of the general sensory fibres of the trigeminal nerve, receiving the large sensory root from the pons |
|---|---|
| Course | Lies in the trigeminal cave over the apex of the petrous temporal bone, lateral to the cavernous sinus; the motor root runs beneath it to join the mandibular division |
| Motor |
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| Sensory |
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The ganglion is the target of percutaneous treatments for trigeminal neuralgia, in which a needle passed through the cheek and foramen ovale is used for radiofrequency thermocoagulation, glycerol injection or balloon compression. Varicella zoster virus lying dormant here reactivates as herpes zoster ophthalmicus, and vesicles on the tip of the nose (Hutchinson sign) warn of eye involvement. Tumours such as schwannomas and meningiomas in Meckel cave cause facial numbness and pain.
Brief electric shock pains in one or more trigeminal divisions, often triggered by touch, chewing or talking, usually due to a blood vessel compressing the nerve root. Treatment starts with carbamazepine, followed by microvascular decompression or ganglion-directed procedures when needed.
Reactivation of the virus from the trigeminal ganglion causes a painful rash in the ophthalmic division and can damage the cornea and inner eye, so urgent antiviral treatment and eye review are needed.
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