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A prospective study of percutaneous retrogasserian glycerol rhizotomy (PRGR) with and without metrizamide trigeminal cisternography is reported in the treatment of the trigeminal neuralgia. A series of 100 patients with typical trigeminal neuralgia were allocated randomly to two treatment groups: Group I patients received PRGR with trigeminal cisternography (50 cases) and Group II patients received PRGR without trigeminal cisternography (50 cases). The results indicate that PRGR without trigeminal cisternography is a valid alternative to the original technique. Factors that assured the accurate performance of the modified technique proposed in this study were: spontaneous cerebrospinal fluid drainage; radiologically confirmed placement of the thin spinal needle at the clival edge into the trigeminal impression of the petrous apex and in the center of the foramen ovale; a positive response to the glycerol test; clinical control of the final glycerol injection; and an alert and cooperating patient throughout the entire procedure.

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Bilateral traumatic abducens nerve palsy is a rare condition. Here a case without skull fracture and associated with cervical spine fracture is reported. Only two cases like this were found in a review of the literature. The mechanism of the lesion is discussed in light of the two main theories proposed thus far. When the injury is acute, as happens in the majority of cases, the nerve lesion probably is due to contusion and stretch of the nerve trunk against the ridge of the petrous bone and the rigid dural hole of entrance in the extradural space at the basilar process.