Percutaneous trigeminal glycerol rhizotomy as a treatment for trigeminal neuralgia

ABSTRACT

To evaluate the efficacy of percutaneous trigeminal glycerol rhizotomy in 15 patients with trigeminal neuralgia, who were either not responding or only partially responding to medical therapy. Design: Case - series study. Setting: Neurosurgical Unit, Mosul Teaching Hospital, during the period from May 1992 to July 1994. Patients and All patients were investigated by plain skull radiographs and CT examinations to rule out the possibility of tumour or any other pathology. The injection was done in the operating theater aided by TV screen using sterile undiluted glycerol. The foramen ovale was approached percutaneously 2.5-3 cm. lateral to the angle of the mouth. The injection was given into the retrogasserian rootlets while the patient was in a semisitting position with the neck being slightly flexed. Trigeminal sensations were tested 2 hours post-injection. The final results after 9-36 months follow-up period indicated that 8 patients had complete pain relief and 3 patients had mild residual pain controlled adequately by medications making a total of 11 patients [73%] who had good pain control. No serious or long lasting complications were encountered. This method of treatment appeared to be useful in old frail patients especially after failure of medical therapy. It is also of value in managing patients with bilateral trigeminal neuralgia