Percutaneous retrogasserian glycerol rhizotomy for patients with idiopathic trigeminal neuralgia: a prospective analysis of factors related to pain relief

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Object. The goal of this study was to analyze prospectively factors associated with facial pain outcomes after percutaneous retrogasserian glycerol rhizotomy (PRGR) for patients with medically unresponsive idiopathic trigeminal neuralgia.

Methods. Between July 1999 and December 2003, 98 patients underwent PRGR in the manner described by Håkanson. The mean patient age was 72.1 years and the average pain duration prior to PRGR was 8.6 years. Fifty patients (51%) had previously undergone surgery. In six patients (6%), the trigeminal cistern could not be defined and the procedure was aborted; six patients were lost to follow-up review. An excellent facial pain outcome was defined as the absence of facial pain without medications.

Thirty-two (35%) of 92 patients either received no benefit (17 patients) or experienced recurrent pain (15 patients) and required additional surgery at a mean of 7.5 months after PRGR; the mean duration of follow-up review in the other 60 patients was 28.7 months (range 3–52 months). Including patients who did not receive a glycerol injection, the 1- and 3-year chances of an excellent facial pain outcome were 61 and 50%, respectively. A multivariate analysis of clinical and surgical factors showed that the facial pain exhibited on glycerol injection correlated with excellent facial pain outcomes (relative risk [RR] = 1.02; 95% confidence interval [CI] 0.26–1.77; p < 0.01), whereas patients who experienced any constant pain less frequently had excellent outcomes (RR = 1.13; 95% CI 0.06–2.20; p = 0.04). Forty-six patients (53%) experienced either mild numbness/parathesias (39 patients) or dysesthesias (seven patients). New trigeminal deficits after PRGR were associated with excellent facial pain outcomes (RR = 1.25; 95% CI 0.56–1.93; p < 0.001).

Conclusions. Percutaneous retrogasserian glycerol rhizotomy remains a good operation for patients with medically unresponsive trigeminal neuralgia who are considered poor candidates for posterior fossa exploration. Predictive factors for success include patients without any constant facial pain, patients with immediate facial pain during glycerol injection, and patients with new trigeminal deficits after PRGR.

Article Information

Address reprint requests to: Bruce E. Pollock, M.D., Department of Neurological Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. email: pollock.bruce@mayo.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Results of PRGR for patients with idiopathic trigeminal neuralgia.

  • View in gallery

    Results of PRGR with respect to facial pain during glycerol injection. Seventy-one patients with facial pain during glycerol injection (solid line) had better outcomes than 15 patients without facial pain during glycerol injection (dotted line) (p < 0.01).

  • View in gallery

    Results of PRGR with respect to the constant pain component before surgery. Eighty-one patients without a constant pain component (solid line) had better outcomes than five patients with a constant pain component (dotted line) (p = 0.04).

  • View in gallery

    Results of PRGR with respect to new or worsened trigeminal deficits after surgery. Forty-six patients with new deficits (solid line) had better outcomes than 40 patients without new deficits (dotted line) (p < 0.001).

References

  • 1.

    Apfelbaum RI: Neurovascular decompression: the procedure of choice? Clin Neurosurg 46:4734982000Apfelbaum RI: Neurovascular decompression: the procedure of choice? Clin Neurosurg 46:473–498 2000

    • Search Google Scholar
    • Export Citation
  • 2.

    Barker FG IIJannetta PJBissonette DJLarkins MWJho HD: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:107710831996Barker FG II Jannetta PJ Bissonette DJ Larkins MW Jho HD: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334:1077–1083 1996

    • Search Google Scholar
    • Export Citation
  • 3.

    Bergenheim ATShamsgovara PRidderheim PA: Microvascular decompression for trigeminal neuralgia: no relation between sensory disturbance and outcome. Stereotact Funct Neurosurg 68:2002061997Bergenheim AT Shamsgovara P Ridderheim PA: Microvascular decompression for trigeminal neuralgia: no relation between sensory disturbance and outcome. Stereotact Funct Neurosurg 68:200–206 1997

    • Search Google Scholar
    • Export Citation
  • 4.

    Blomstedt PCBergenheim AT: Technical difficulties and perioperative complications of retrogasserian glycerol rhizotomy for trigeminal neuralgia. Stereotact Funct Neurosurg 79:1681812002Blomstedt PC Bergenheim AT: Technical difficulties and perioperative complications of retrogasserian glycerol rhizotomy for trigeminal neuralgia. Stereotact Funct Neurosurg 79:168–181 2002

    • Search Google Scholar
    • Export Citation
  • 5.

    Brisman R: Gamma knife surgery with a dose of 75 to 76.8 Gy for trigeminal neuralgia. J Neurosurg 100:8488542004Brisman R: Gamma knife surgery with a dose of 75 to 76.8 Gy for trigeminal neuralgia. J Neurosurg 100:848–854 2004

    • Search Google Scholar
    • Export Citation
  • 6.

    Broggi GFerroli PFranzini AServello DDones I: Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 68:59642000Broggi G Ferroli P Franzini A Servello D Dones I: Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 68:59–64 2000

    • Search Google Scholar
    • Export Citation
  • 7.

    Brown JAMcDaniel MDWeaver MT: Percutaneous trigeminal nerve compression for treatment of trigeminal neuralgia: results in 50 patients. Neurosurgery 32:5705731993Brown JA McDaniel MD Weaver MT: Percutaneous trigeminal nerve compression for treatment of trigeminal neuralgia: results in 50 patients. Neurosurgery 32:570–573 1993

    • Search Google Scholar
    • Export Citation
  • 8.

    Burchiel KJ: A new classification for facial pain. Neurosurgery 53:116411672003Burchiel KJ: A new classification for facial pain. Neurosurgery 53:1164–1167 2003

    • Search Google Scholar
    • Export Citation
  • 9.

    Burchiel KJ: Percutaneous retrogasserian glycerol rhizolysis in the management of trigeminal neuralgia. J Neurosurg 69:3613661988Burchiel KJ: Percutaneous retrogasserian glycerol rhizolysis in the management of trigeminal neuralgia. J Neurosurg 69:361–366 1988

    • Search Google Scholar
    • Export Citation
  • 10.

    Burchiel KJClarke HHaglund MLoeser JD: Long-term efficacy of microvascular decompression in trigeminal neuralgia. J Neurosurg 69:35381988Burchiel KJ Clarke H Haglund M Loeser JD: Long-term efficacy of microvascular decompression in trigeminal neuralgia. J Neurosurg 69:35–38 1988

    • Search Google Scholar
    • Export Citation
  • 11.

    Dandy WE: Concerning the cause of trigeminal neuralgia. Am J Surg 24:4474551934Dandy WE: Concerning the cause of trigeminal neuralgia. Am J Surg 24:447–455 1934

    • Search Google Scholar
    • Export Citation
  • 12.

    Fujimaki TFukushima TMiyazaki S: Percutaneous retrogasserian glycerol injection in the management of trigeminal neuralgia: long-term follow-up results. J Neurosurg 73:2122161990Fujimaki T Fukushima T Miyazaki S: Percutaneous retrogasserian glycerol injection in the management of trigeminal neuralgia: long-term follow-up results. J Neurosurg 73:212–216 1990

    • Search Google Scholar
    • Export Citation
  • 13.

    Håkanson S: Trigeminal neuralgia treated by the injection of glycerol into the trigeminal cistern. Neurosurgery 9:6386461981Håkanson S: Trigeminal neuralgia treated by the injection of glycerol into the trigeminal cistern. Neurosurgery 9:638–646 1981

    • Search Google Scholar
    • Export Citation
  • 14.

    Jannetta PJ: Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 26 (Suppl):1591621967Jannetta PJ: Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 26 (Suppl):159–162 1967

    • Search Google Scholar
    • Export Citation
  • 15.

    Kanpolat YSavas ABekar ABerk C: Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience in 1,600 patients. Neurosurgery 48:5245342001Kanpolat Y Savas A Bekar A Berk C: Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience in 1600 patients. Neurosurgery 48:524–534 2001

    • Search Google Scholar
    • Export Citation
  • 16.

    Kaplan ELMeier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:4574811958Kaplan EL Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481 1958

    • Search Google Scholar
    • Export Citation
  • 17.

    Lee KHChang JWPark YGChung SS: Microvascular decompression and percutaneous rhizotomy in trigeminal neuralgia. Stereotact Funct Neurosurg 68:1961991997Lee KH Chang JW Park YG Chung SS: Microvascular decompression and percutaneous rhizotomy in trigeminal neuralgia. Stereotact Funct Neurosurg 68:196–199 1997

    • Search Google Scholar
    • Export Citation
  • 18.

    Lopez BCHamlyn PJZakrzewska JM: Systematic review of ablative neursurgical techniques for the treatment of trigeminal neuralgia. Neurosurgery 54:9739832004Lopez BC Hamlyn PJ Zakrzewska JM: Systematic review of ablative neursurgical techniques for the treatment of trigeminal neuralgia. Neurosurgery 54:973–983 2004

    • Search Google Scholar
    • Export Citation
  • 19.

    Lunsford LDBennett MH: Percutaneous retrogasserian glycerol rhizotomy for tic douloureux: Part 1. Technique and results in 112 patients. Neurosurgery 14:4244301984Lunsford LD Bennett MH: Percutaneous retrogasserian glycerol rhizotomy for tic douloureux: Part 1. Technique and results in 112 patients. Neurosurgery 14:424–430 1984

    • Search Google Scholar
    • Export Citation
  • 20.

    Maesawa SSalame CFlickinger JCPirris SKondziolka DLunsford LD: Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 94:14202001Maesawa S Salame C Flickinger JC Pirris S Kondziolka D Lunsford LD: Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 94:14–20 2001

    • Search Google Scholar
    • Export Citation
  • 21.

    Massager NLorenzoni JDevriendt DDesmedt FBrotchi JLevivier M: Gamma knife surgery for idiopathic trigeminal neuralgia performed using a far-anterior cisternal target and a high dose of radiation. J Neurosurg 100:5976052004Massager N Lorenzoni J Devriendt D Desmedt F Brotchi J Levivier M: Gamma knife surgery for idiopathic trigeminal neuralgia performed using a far-anterior cisternal target and a high dose of radiation. J Neurosurg 100:597–605 2004

    • Search Google Scholar
    • Export Citation
  • 22.

    North RBKidd DHPiantadosi SCarson BS: Percutaneous retrogasserian glycerol rhizotomy: predictors of success and failure in treatment of trigeminal neuralgia. J Neurosurg 72:8518561990North RB Kidd DH Piantadosi S Carson BS: Percutaneous retrogasserian glycerol rhizotomy: predictors of success and failure in treatment of trigeminal neuralgia. J Neurosurg 72:851–856 1990

    • Search Google Scholar
    • Export Citation
  • 23.

    Pollock BEEcker RD: A prospective cost-effectiveness study of trigeminal neuralgia surgery. Clin J Pain (In press)Pollock BE Ecker RD: A prospective cost-effectiveness study of trigeminal neuralgia surgery. Clin J Pain (In press)

    • Search Google Scholar
    • Export Citation
  • 24.

    Pollock BEPhuong LKFoote RLStafford SLGorman DA: High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction. Neurosurgery 49:58642001Pollock BE Phuong LK Foote RL Stafford SL Gorman DA: High-dose trigeminal neuralgia radiosurgery associated with increased risk of trigeminal nerve dysfunction. Neurosurgery 49:58–64 2001

    • Search Google Scholar
    • Export Citation
  • 25.

    Pollock BEPhuong LKGorman DAFoote RLStafford SL: Stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 97:3473532002Pollock BE Phuong LK Gorman DA Foote RL Stafford SL: Stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 97:347–353 2002

    • Search Google Scholar
    • Export Citation
  • 26.

    Saini SS: Retrogasserian anhydrous glycerol injection therapy in trigeminal neuralgia: observations in 552 patients. J Neurol Neurosurg Psychiatry 50:153615381987Saini SS: Retrogasserian anhydrous glycerol injection therapy in trigeminal neuralgia: observations in 552 patients. J Neurol Neurosurg Psychiatry 50:1536–1538 1987

    • Search Google Scholar
    • Export Citation
  • 27.

    Sindou MHoweidy TAcevedo G: Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia (with correlations between topography of pain and site of the neurovascular conflict). Prospective study in a series of 579 patients. Acta Neurochir 144:1132002Sindou M Howeidy T Acevedo G: Anatomical observations during microvascular decompression for idiopathic trigeminal neuralgia (with correlations between topography of pain and site of the neurovascular conflict). Prospective study in a series of 579 patients. Acta Neurochir 144:1–13 2002

    • Search Google Scholar
    • Export Citation
  • 28.

    Skirving DJDan NG: A 20-year review of percutaneous balloon compression of the trigeminal ganglion. J Neurosurg 94:9139172001Skirving DJ Dan NG: A 20-year review of percutaneous balloon compression of the trigeminal ganglion. J Neurosurg 94:913–917 2001

    • Search Google Scholar
    • Export Citation
  • 29.

    Smith ZADeSalles AAFrighetto LGoss BLee SPSelch Met al: Dedicated linear accelerator radiosurgery for the treatment of trigeminal neuralgia. J Neurosurg 99:5115162003Smith ZA DeSalles AA Frighetto L Goss B Lee SP Selch M et al: Dedicated linear accelerator radiosurgery for the treatment of trigeminal neuralgia. J Neurosurg 99:511–516 2003

    • Search Google Scholar
    • Export Citation
  • 30.

    Taha JMTew JM JrBuncher CR: A prospective 15-year follow-up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomy. J Neurosurg 83:9899931995Taha JM Tew JM Jr Buncher CR: A prospective 15-year follow-up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomy. J Neurosurg 83:989–993 1995

    • Search Google Scholar
    • Export Citation
  • 31.

    Theodosopoulos PVMarco EApplebury CLamborn KRWilson CB: Predictive model for pain recurrence after posterior fossa surgery for trigeminal neuralgia. Arch Neurol 59:129713022002Theodosopoulos PV Marco E Applebury C Lamborn KR Wilson CB: Predictive model for pain recurrence after posterior fossa surgery for trigeminal neuralgia. Arch Neurol 59:1297–1302 2002

    • Search Google Scholar
    • Export Citation
  • 32.

    Tronnier VMRasche DHamer JKienle ALKunze S: Treatment of idiopathic trigeminal neuralgia: comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompression. Neurosurgery 48:126112682001Tronnier VM Rasche D Hamer J Kienle AL Kunze S: Treatment of idiopathic trigeminal neuralgia: comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompression. Neurosurgery 48:1261–1268 2001

    • Search Google Scholar
    • Export Citation
  • 33.

    Yoon KBWiles JRMiles JBNurmikko TJ: Long-term outcome of percutaneous thermocoagulation for trigeminal neuralgia. Anaesthesia 54:8038081999Yoon KB Wiles JR Miles JB Nurmikko TJ: Long-term outcome of percutaneous thermocoagulation for trigeminal neuralgia. Anaesthesia 54:803–808 1999

    • Search Google Scholar
    • Export Citation
  • 34.

    Young RF: Glycerol rhizolysis for treatment of trigeminal neuralgia. J Neurosurg 69:39451988Young RF: Glycerol rhizolysis for treatment of trigeminal neuralgia. J Neurosurg 69:39–45 1988

    • Search Google Scholar
    • Export Citation

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