Reduced Effect of Percutaneous Retrogasserian Glycerol Rhizolysis in Trigeminal Neuralgia Affecting the Third Branch

IntroductionThe objective of this study was to determine the long-term efficacy of percutaneous glycerol rhizolysis of the trigeminal ganglion for treating patients with trigeminal neuralgia and search for predictors associated with (long-term) benefit to improve patient selection. MethodsA retrospective study in 60 consecutive patients treated with percutaneous glycerol rhizolysis of the trigeminal ganglion for trigeminal neuralgia. Charts were reviewed in combination with follow-up by questionnaire (n=55, 92% response). ResultsInitial pain relief was achieved in 92% of the patients. Pain-free survival was 59% of the patients at 12months and 53% at 24months. Most common side effects were hypesthesia (15%), dry eye (5%), and meningitis (2%). In patients without involvement of the third branch of the trigeminal nerve, the initial effect was 79%, of which 90% achieved more than 2years pain-free survival, compared with 97% initial effect and less than 40% pain-free survival of more than 2years when the third trigeminal branch was involved. DiscussionThe present study demonstrates that involvement of the third branch is a negative predictor for long-term outcome in percutaneous glycerol rhizolysis of the trigeminal ganglion in patients with classical trigeminal neuralgia. However, in the absence of third-branch involvement, glycerol rhizolysis yields excellent long-term results when initial positive effect is obtained.