title: Glycerol rhizotomy via a retrosigmoid approach as an alternative treatment for trigeminal neuralgia.
abstract: OBJECTIVE
  Trigeminal neuralgia is a sensory nerve disorder characterized by lancinating pain and treated most commonly with carbamazepine, rhizotomy treatment, or open surgical management with microvascular decompression. We describe a novel technique to complement surgical treatment for trigeminal neuralgia via direct injection of the trigeminal nerve with glycerin in the cisternal portion of the nerve.
  
  
  METHODS
  We performed a retrospective analysis of patients who received standard microvascular decompression and injection of glycerin to the inferior third of the cisternal portion of the nerve anterior to the root entry zone with lack of a compressive vessel on MRI as the primary indication. Fourteen patients were identified and demographic information, post-operative course and complications were recorded.
  
  
  RESULTS
  There were eleven females and three males with an average age at time of surgery of 54.8 years. 100% of patients reported that their trigeminal pain was significantly improved following surgical intervention. Four out of fourteen patients reported a 50-80% decrease from the pre-surgery baseline pain at one month and three month follow up. One patient developed a CSF leak, and no surgical site infections or motor deficits were observed.
  
  
  CONCLUSIONS
  Intra-operative glycerin rhizotomy in conjunction with microvascular decompression can be used to safely treat patients suffering from trigeminal neuralgia.
authors.affiliation: The Johns Hopkins Hospital, Department of Neurosurgery, Baltimore, USA. Electronic address: rory@jhmi.edu.
authors.forename: C Rory
authors.initials: CR
authors.lastname: Goodwin
authors.forename: Jesse X
authors.initials: JX
authors.lastname: Yang
authors.forename: Chetan
authors.initials: C
authors.lastname: Bettegowda
authors.forename: Brian
authors.initials: B
authors.lastname: Hwang
authors.forename: Carol
authors.initials: C
authors.lastname: James
authors.forename: Ann
authors.initials: A
authors.lastname: Biser
authors.forename: Shaan
authors.initials: S
authors.lastname: Raza
authors.forename: Matthew
authors.initials: M
authors.lastname: Bender
authors.forename: Benjamin
authors.initials: B
authors.lastname: Carson
authors.forename: John Y K
authors.initials: JY
authors.lastname: Lee
authors.forename: Michael
authors.initials: M
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005990:Glycerol; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D061145:Microvascular Decompression Surgery / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D019051:Rhizotomy / Q000379:methods*; D014276:Trigeminal Nerve / Q000473:pathology / Q000601:surgery; D014277:Trigeminal Neuralgia / Q000601:surgery*
chemical_list: D005990:Glycerol
keywords: Glycerin rhizotomy; Retrosigmoid; Tic douloureux; Trigeminal neuralgia