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Long-Term Results after Glycerol Rhizotomy for Multiple Sclerosis-Related Trigeminal Neuralgia

Published online by Cambridge University Press:  18 September 2015

Douglas Kondziolka ,
L. Dade Lunsford  and
David J. Bissonette
Douglas Kondziolka*
Affiliation:
Department of Neurological Surgery, University of Pittsburgh and the Specialized Neurosurgical Center, Presbyterian University Hospital, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh
L. Dade Lunsford
Affiliation:
Department of Neurological Surgery, University of Pittsburgh and the Specialized Neurosurgical Center, Presbyterian University Hospital, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh
David J. Bissonette
Affiliation:
Department of Neurological Surgery, University of Pittsburgh and the Specialized Neurosurgical Center, Presbyterian University Hospital, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh
*
Department of Neurological Surgery, B-400 Presbylerian University Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A. 15213
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Abstract:

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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.

Résumé:

RÉSUMÉ:

La rhizotomie percutanée rétrogassérienne au glycérol (RPRG) a été utilisée pendant une période de 11 ans chez 53 patients avec une névralgie du trijumeau typique associée à une sclérose en plaques. Chez tous les patients, tous les traitements médicaux avaient échoué antérieurement. Un soulagement complet de la douleur (aucune médication) à long terme (suivi médian de 36 mois) a été obtenu chez 29 (59%) des 49 patients qu'on a pu évaluer. Huit patients (16%) ont obtenu un contrôle satisfaisant de la douleur, mais ont eu besoin occasionnellement d'une medication. Douze patients (25%) ont eu un résultat insatisfaisant initialement; neuf ont subi d'autres manoeuvres chirurgicales. Seize patients (30%) ont eu besoin d'une nouvelle rhizotomie au glycérol pour contrôler la douleur. Vingt-sept patients (60%) des 45 patients évalués pour ce critère ont conservé une perception sensitive normale au niveau du trijumeau après l'injection. Un seul patient, qui avait subi quatre rhizotomies au glycérol sur une période de 25 mois, a développé un déficit sensitif majeur. Aucun patient n'a développé de douleur de désafférentiation. Nous pensons que la RPRG est une manoeuvre chirurgicale efficace, qui a un taux de morbidité bas et qui peut être répétée, pour le traitement de la névralgie du trijumeau, chez les patients porteurs d'une sclérose en plaques.

Type
Articles
Information
Canadian Journal of Neurological Sciences , Volume 21 , Issue 2 , May 1994 , pp. 137 - 140
Copyright
Copyright © Canadian Neurological Sciences Federation 1994

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