Percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia

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Abstract
✓ A prospective study of percutaneous retrogasserian glycerol rhizotomy (PRGR) with and without metrizamide trigeminal cisternography is reported in the treatment of the trigeminal neuralgia. A series of 100patients with typical trigeminal neuralgia were allocated randomly to two treatment groups: Group I patients received PRGR with trigeminal cisternography (50 cases) and Group II patients received PRGR without trigeminal cisternography (50 cases). The results indicate that PRGR without trigeminal cisternography is a valid alternative to the original technique. Factors that assured the accurate performance of the modified technique proposed in this study were: 1) spontaneous cerebrospinal fluid drainage; 2) radiologically confirmed placement of the thin spinal needle at the clival edge into the trigeminal impression of the petrous apex and in the center of the foramen ovale; 3) a positive response to the glycerol test; 4) clinical control of the final glycerol injection; and 5) an alert and cooperating patient throughout the entire procedure.