Treatment of trigeminal neuralgia by thermocoagulation, glycerolization, and percutaneous compression of the gasserian ganglion and/or retrogasserian rootlets: long-term results and therapeutic protocol.
From 1976 to 1986, 681 patients with drug-refractory trigeminal neuralgia (TN)--typical in 641, symptomatic of multiple sclerosis in 23 and of tumor in 10, atypical in 5, and postherpetic in 2--were treated with various percutaneous procedures. Controlled differential thermocoagulation of the gasserian ganglion and/or retrogasserian rootlets was performed in 533 patients; glycerolization of the trigeminal cistern in 32; and compression of the gasserian ganglion by balloon catheter in 159. Results and complications of each procedure are assessed at a mean follow-up of 6.5 years for thermocoagulation, 5 years for glycerolization, and 3.5 years for compression. The following therapeutic protocol is proposed: 1) in TN patients at first operation: a) gasserian compression (or glycerolization, if experience warrants it) is indicated in all cases of typical TN, unless the 3rd division alone is affected; b) in the latter case and in symptomatic TN, we suggest thermocoagulation; 2) in recurrences: a) after glycerolization or gasserian compression, gasserian compression (or glycerolization) is indicated; b) after thermocoagulation or open surgery, thermocoagulation is suggested.
1st Neurosurgical Division, University of Rome La Sapienza, Italy.
B
B
Fraioli
V
V
Esposito
B
B
Guidetti
G
G
Cruccu
M
M
Manfredi
D002404:Catheterization; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D004564:Electrocoagulation; D005990:Glycerol / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D011312:Pressure; D013126:Spinal Nerve Roots / Q000601:surgery; D013997:Time Factors; D012668:Trigeminal Ganglion / Q000601:surgery*; D014276:Trigeminal Nerve / Q000601:surgery*; D014277:Trigeminal Neuralgia / Q000628:therapy*
D005990:Glycerol