Meningitis after percutaneous radiofrequency trigeminal ganglion lesion. Case report and review of literature.

CASE REPORT: A 79-year-old man with severe trigeminal neuralgia presented to the pain clinic, and was offered a radiofrequency trigeminal ganglion lesion. He had only partial response to the first procedure, so a second was undertaken. The following day he presented with signs of meningitis and the diagnosis was confirmed on lumbar puncture. He was treated with appropriate antibiotics, and recovered well. LITERATURE REVIEW: The current literature on reports of meningitis after percutaneous trigeminal ganglion lesioning reveals an overall mean incidence of meningitis of 0.15% (confidence interval 0.10-0.21). The Scottish Intercollegiate Guidelines Network guide the decision on the routine use of antimicrobial prophylaxis, and although the risk of infection can be estimated from the literature and the severity of infection is high, the effectiveness and consequences of prophylaxis cannot be established.
CONCLUSION: If breach of the oral mucosa has occurred, then antibiotic prophylaxis should be administered.