Long-term results after glycerol rhizotomy for multiple sclerosis-related trigeminal neuralgia.
Percutaneous retrogasserian glycerol rhizotomy (PRGR) was used during an 11-year interval in 53 patients with typical trigeminal neuralgia associated with multiple sclerosis. All patients had failed extensive medical trials prior to PRGR. Long-term (median follow-up, 36 months) complete pain relief (no further medication) was achieved in 29 (59%) of 49 evaluable patients. Eight patients (16%) had satisfactory pain control but required occasional medication. Twelve patients (25%) had initial unsatisfactory results with inadequate pain relief; nine underwent alternative surgical procedures. Sixteen patients (30%) subsequently required repeat glycerol rhizotomies to reachieve pain control. Twenty-seven patients (60% of 45 patients evaluated for this finding) retained normal trigeminal sensation after injection. Major trigeminal sensory loss developed in a single patient who had four glycerol rhizotomies over a 25-month interval. No patient developed deafferentation pain. We believe that PRGR is a low-morbidity, effective, and repeatable surgical procedure for the management of trigeminal neuralgia in the setting of multiple sclerosis.
Kondziolka
D
D
Department of Neurological Surgery, University of Pittsburgh, Pennsylvania 15213.
Lunsford
L D
LD
Bissonette
D J
DJ
D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D005990:Glycerol; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D010146:Pain / Q000601:surgery*; D013997:Time Factors; D014277:Trigeminal Neuralgia / Q000209:etiology / Q000601:surgery*
D005990:Glycerol