Treatment of trigeminal neuralgia by thermocoagulation, glycerolization, and percutaneous compression of the gasserian ganglion and/or retrogasserian rootlets: long-term results and therapeutic protocol

• Published in: Neurosurgery Vol. 24; no. 2; p. 239
• Main Authors: Fraioli, B, Esposito, V, Guidetti, B, Cruccu, G, Manfredi, M
• Format: Journal Article
• Language: English
• Published: United States 01.02.1989
• Subjects: Catheterization; Clinical Protocols; Combined Modality Therapy; Electrocoagulation; Glycerol - administration & dosage; Glycerol - therapeutic use; Humans; Pressure; Spinal Nerve Roots - surgery; Time Factors; Trigeminal Ganglion - surgery; Trigeminal Nerve - surgery; Trigeminal Neuralgia - therapy
• ISSN: 0148-396X
• DOI: 10.1227/00006123-198902000-00014

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.