Percutaneous retrogasserian glycerol rhizotomy for multiple sclerosis-related trigeminal neuralgia

ABSTRACT

Approximately two percent of patients with multiple sclerosis [MS] develop trigeminal neuralgia. In multiple sclerosis, Plaque within brainstem may cause trigeminal neuralgia that is often poorly responsive to microvascular decompression. For multiple sclerosis trigeminal neuralgia patients who are refractory to medication regimens, percutaneous trigeminal operations have been advocated. This study was done at Johns Hopkins University Hospital in the United State of America. During the 4-years period from 1995 to 1998, 42 patients suffering from trigeminal neuralgia with MS were treated with percutaneous glycerol rhizotomies [28 females, 14 males, median age 54 years]. These patients represented a subset of 448 patients who had this procedure for trigeminal neuralgia during the same period. The majority of patients without MS were older; 72% above the age of 57 years. Percutaneous retrogasserian glycerol rhiztomy [PROR] is performed with the patient awake but under intravenous sedation. There was no major morbidity related to glycerol rhizotomy and no mortality. The pain relief occurred, it did so immediately in approximately half the patients, over 1-2 weeks in the other half. Detailed follow-up three months or more after surgery was available for all the patients. The follow-up 31 of these patients [73.8%] had complete pain relief and required no medications for trigeminal neuralgia. An additional five patients [11.9%] achieved pain control in conjunction with reduced medication intake. Six patients [14.2%] had inadequate pain relief although three initially had complete pain relief lasting 3, 5, and 10 months respectively. Two of these six patients with inadequate relief were uncontrolled with medication and required subsequent surgical procedures. The patients evaluated for any trigeminal sensory changes, a descriptive assessment of facial numbness was used. Thirty patients [71.4%] continued to have normal facial sensation after glycerol rhizotomy. Finally, single or repeated percutaneous glycerol rhizotomy is a safe, well tolerated, and efficacious procedure for most patients with trigeminal neuralgia related to multiple sclerosis. The development of marked facial hypoesthesia is rare, and usually only observed after multiple rhizotomies