Glycerol rhizolysis for treatment of trigeminal neuralgia

Percutaneous retrogasserian glycerol instillation was performed under local anesthesia for treatment of trigeminal neuralgia in 162 patients. A simplified technique that did not involve cisternography was used. Initial pain relief was achieved in 146 patients (90.1%). Recurrent pain was noted in 27 patients (18.5%) and was more frequent (50%) in patients who had undergone surgical treatments prior to glycerol injection than in those who had no previous surgical treatment (12.3%). A second glycerol injection was carried out in nine patients and a third injection in two patients. The follow-up period extended from 6 to 67 months and 77.8% of patients are totally pain-free after one or more glycerol injections. Another 8.6% experienced good pain relief with the addition of small doses of pharmacological agents. Thus, 140 (86.4%) of the original 162 patients experienced satisfactory pain control following glycerol rhizolysis. Initial sensory loss on the face occurred in 117 patients (71.6%) but at last follow-up examination only 46 patients (28%) experienced mild orofacial hypalgesia and 13 patients (8%) noted analgesia. The corneal reflex was absent in three patients (1.8%) and reduced in five (3.1%). No patients noted corneal ulceration or anesthesia dolorosa. Percutaneous retrogasserian glycerol rhizolysis offers a rapid, safe, reliable, and relatively inexpensive surgical approach to treatment of trigeminal neuralgia.