Summary
We have evaluated the long-term results of percutaneous retrogasserian glycerol rhizotomy (PRGR) in 60 patients with classical trigeminal neuralgia. Complete initial pain relief was achieved in 93% of the patients. Numbness was initially reported by 3/4 of the patients and at follow-up by 1/3, while long-lasting dysaesthesias were an important side effect in 38% of previously untreated patients. The half-life of the method was 47 months in our material, and this figure compares favourably with other previously reported series. The method carries a significant risk of long-lasting and troublesome sensory disturbances. Another disadvantage of the method, reported in the present long-term study, was the high incidence of recurrent neuralgia.
We are unable to identify predictors of recurrent neuralgia after PRGR, although major recurrences were more common in patients with unchanged facial sensation postoperatively.
In conclusion, PRGR offers safe and reliable relief of pain in patients with trigeminal neuralgia. In spite of the high incidence of recurrence and of long-lasting dysaesthesias it is, in our opinion, the method of choice in the elderly, and particularly suitable for patients at high risk.
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References
Arias MJ (1986) Percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia. J Neurosurg 65: 32–36
Broggi C, Franzini A, Lasio G, Giorgi C, Servello D (1990) Long-term results of percutaneous retrogasserian thermorhizotomy for “essential” trigeminal neuralgia: considerations in 1000 consecutive patients. Neurosurgery 26: 783–787
Burchiel KJ (1988) Percutaneous retrogasserian glycerol rhizolysis in the management of trigeminal neuralgia. J Neurosurg 69: 361–366
Fraioli B, Esposito V, Guidetti B, Cruccu G, Manfredi M (1989) Treatment of trigeminal neuralgia by thermocoagulation, glycerolization, and percutaneous compression of the Gasserian ganglion and/or Retrogasserian rootlets: Long-term results and therapeutic protocol. Neurosurgery 24: 239–245
Fujimaki T, Fukushima T, Miyazaki S (1990) Percutaneous retrogasserian glycerol injection in the management of trigeminal neuralgia. Long-term follow-up results. J Neurosurg 73: 212–216
Håkanson S (1981) Trigeminal neuralgia treated by the injection of glycerol into the trigeminal cistern. Neurosurgery 9: 638–646
van Loveren H, Tew Jm, Keller JT, Nurre MA (1982) A 10-year experience in the treatment of trigeminal neuralgia. J Neurosurg 57: 757–764
Lunsford LD (1985) Trigeminal neuralgia: treatment by glycerol rhizotomy. In: Wilkins S, Rengachary S (eds) Neurosurgery. McGraw-Hill, New York, pp 2351–2356
North RB, Kidd DH, Piantadosi S, Carson BS (1990) Percutaneous retrogasserian glycerol rhizotomy. J Neurosurg 72: 851–856
Rappaport ZH, Gomorri JM (1988) Recurrent trigeminal cistern glycerol injections for tic douloureux. Acta Neurochir (Wien) 90: 31–34
Sahni KS, Pieper DR, Anderson R, Baldwin NG (1990) Relation of hypesthesia to the outcome of glycerol rhizolysis for trigeminal neuralgia. J Neurosurg 72: 55–58
Saini SS (1987) Retrogasserian anhydrous glycerol injection therapy in trigeminal neuralgia: observations in 552 patients. J Neurol Neurosurg Psychiatry 50: 1536–1538
Sweet WH (1986) The treatment of trigeminal neuralgia (tic douloureux). N Engl J Med 315: 174–177
Sweet WH, Polletti CE (1985) Problems with retrogasserian glycerol in the treatment of trigeminal neuralgia. Appl Neurophysiol 48: 252–257
Szapiro J Jr, Sindou M (1986) Traitement microchirurgical de la névralgie du trijumeau. Neurochirurgie 32: 103–121
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Slettebø, H., Hirschberg, H. & Lindegaard, K.F. Long-term results after percutaneous retrogasserian glycerol rhizotomy in patients with trigeminal neuralgia. Acta neurochir 122, 231–235 (1993). https://doi.org/10.1007/BF01405534
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DOI: https://doi.org/10.1007/BF01405534