Trigeminal nerve peripheral branch phenol/glycerol injections for tic douloureux

Trigeminal neuralgia or tic douloureux is a disease affecting older individuals, and thus, office-based "minimally invasive" therapy is inherently attractive. The author sought to determine whether injection of peripheral trigeminal branches with neurolytic solutions offers a simple, less invasive therapy, with low risk for patients with one- or two-division trigeminal neuralgia that is unresponsive to pharmacotherapy.

This retrospective study focused on a review of case charts from 18 patients treated for tic douloureux. Sixty injections of 10% phenol in glycerol were given to the 18 patients, six of whom had undergone other neurosurgical procedures. The median patient age was 74 years, ranging from 36 to 94 years. There were nine women and nine men. Forty-six injections were administered into the infraorbital nerve in its canal in the midface, 11 percutaneous injections were administered into the mandibular nerve just proximal to the mandibular canal in the ramus of the jaw, and three injections were administered into supraorbital nerves. Eighty-seven percent of injections brought marked or total relief initially. Of those injections that provided initial relief, 37% still provided relief after 1 year and 30% after 2 years, with relief lasting for a median of 9 months after each injection. Most patients whose pain recurred after months of relief requested a repeated procedure, rather than undergo a ganglion nerve block procedure or open surgery. There were no serious complications or dysesthetic pain. Facial sensory loss generally recovered within 6 months and was well tolerated.

Office-based injection of trigeminal branches is a useful technique for neurosurgeons who treat trigeminal neuralgia. It is easily repeated and can provide immediate pain relief of intermediate duration.