Comparison between percutaneous retrogasserian glycerol rhizolysis and percutaneous radiofrequency trigeminal gangliolysis for management of trigeminal neuralgia

Approximately 70% of trigeminal neuralgia [TN] patients are well controlled by medical management. Although they are well controlled initially, many of them will become non-responders and the majority of patients will eventually fail medical management. The aim of this work is to study the difference between 2 of the minor surgical procedures used for treatment of trigeminal neuralgia, namely, percutaneous retrogasserian glycerol rhizolysis [PRGR] and percutaneous radiofrequency trigeminal gangliolysis [PRTG]. Thirty two patients with intractable trigeminal neuralgia, had failed medical treatment were included in the study. The patients were divided into 2 equal groups according to the procedure used, PRGR group and PRTG group under fluoroscopic guidance. It was found that PRTG had faster onset of action, higher success and lesser failure rates than PRGR. Recurrence rates after 6 months and one year were 6.25% and 18.75% for PRTG and 12.5% and 25% for PRGR. The incidence of keratitis was higher with PRTG than PRGR while no case of anaesthesia dolorosa was reported in both techniques. In conclusion, both techniques are effective with relative advantages and disadvantages to each. PRTG disadvantages include requirements for a cooperative patient and access to radiofrequency equipment. Its great merits include high initial success rates and modest rate of recurrence. PRGR has a lesser initial success rate and a higher rate of recurrence than with the thermal therapy. It requires less patient cooperation and minimal equipment and appears to be associated with lower incidences of corneal anaesthsia and keratitis

Evaluation of C2 root ganglioectomy in the management of cervicogenic headache

The aim of this study was to assess the percutaneous radio frequency thermocoagulation in the treatment of occipital pain due to Cl-C2 facet arthrosis. This was a preliminary experience in the management of 175 patients who had presented with occipital pain due to Cl-C2 arthrosis. Medications together with physiotherapy were able to relieve the occipital pain in 63 patients. Nerve block was effective in 97 patients with immediate pain relief, however, there were variable degrees of pain recurrence in both severity and pain free period. Percutaneous radio frequency thermocoagulation was done in 70 patients with a recurrence in nine patients. Percutaneous thermocoagulation was a very effective, easy and safe way to control the cervicogenic headache