Five-and-a-Half Years' Experience with Percutaneous Retrogasserian Glycerol Rhizotomy in Treatment of Trigeminal Neuralgia

Dieckmann, G; Bockermann, V.; Heyer, C.; Henning, Jeremy; Roesen, M.

doi:10.1159/000100748

Cited by 21 publications

(18 citation statements)

References 13 publications

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“…Herpes may therefore be a sign of properly performed rhizolysis. In our series, the frequency was low compared to some other studies [2,5,6,8,9]. However, most eruptions appeared after the patient had been dis-charged from hospital, and the eruptions were often mild and short-lasting, which may explain why patients may have forgotten this complication when follow-up was performed.…”

Section: Discussioncontrasting

confidence: 54%

Technical Difficulties and Perioperative Complications of Retrogasserian Glycerol Rhizotomy for Trigeminal Neuralgia

Blomstedt

Bergenheim

2002

Stereotact Funct Neurosurg

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In 139 patients, 260 consecutive retrogasserian glycerol rhizotomies for trigeminal neuralgia were retrospectively analyzed regarding technical surgical difficulties and immediate and early complications. Technical obstacles occurred in 47.3%. In 21 cases (8.1%), the surgical procedure had to be interrupted due to circumstances such as vasovagal reactions, cardiac arrest, or difficulties to find the trigeminal cistern. Complications or side effects, being either transient or persistent, occurred in 67.3%. In the vast majority, those unwanted effects were related to mild sensory deficits. However, in 28.1% the complications were other than mild affection of facial sensibility. These slightly graver complications included labial herpes (3.8%), anesthesia dolorosa (0.8%), moderate or severe affection of sensibility (18.8%), dysesthesia (22.7%), chemical meningitis (1.5%) and infectious meningitis (1.5%). In 5 patients (1.9%) hearing was affected. In one of them, this condition was also brought about by tinnitus, and in another patient a preexisting tinnitus deteriorated. Although the frequency of surgical difficulties was high, the success of the glycerol injection was hampered only in a minor number of procedures. The frequency of complications and side effects was high, but they were mostly mild due to their nature and non-disabling for the patient. However, long-lasting disabling side effects occurred, and this should not be neglected when informing patients preoperatively. The surgical training needed to perform the procedure is stressed, and the use of prophylactic antibiotics when accidentally penetrating the oral bucca is recommended. We consider retrogasserian glycerol rhizotomy to be a good surgical option for patients with trigeminal neuralgia not suitable for microvascular decompression and when pharmacological therapy is not sufficient or is not tolerated.

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Section: Discussioncontrasting

confidence: 54%

Technical Difficulties and Perioperative Complications of Retrogasserian Glycerol Rhizotomy for Trigeminal Neuralgia

Blomstedt

Bergenheim

2002

Stereotact Funct Neurosurg

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“…Cheng et al [3] reported that pain recurred in 9 of 16 patients after alcohol blocks, in 2 of 7 patients after radiofrequency rhizotomy and in 2 of 6 patients after PRGR. Dieckmann et al [18] reported that PRGR for patients with idiopathic trigeminal neuralgia was associated with initial pain relief in 91% but a recurrence rate of 11% within the first 2 years. Steiger [19] reported 122 patients who underwent PRGR.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Radiosurgery for Patients with Trigeminal Neuralgia Associated with Petroclival Meningiomas

Kano

Awan²,

Flannery

et al. 2010

Stereotact Funct Neurosurg

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Background:The management of trigeminal neuralgia in patients with associated skull base meningiomas is complex. Objective:We evaluated the pain management needs and outcomes in patients with petroclival meningiomas associated with medically refractory trigeminal neuralgia. Methods: During a 21-year period, 168 patients underwent stereotactic radiosurgery (SRS) for meningiomas involving the petroclival region. We identified 12 patients (10 females; median age 54 years) who had trigeminal neuralgia in association with an ipsilateral petroclival meningioma. The median tumor volume was 3.8 cm³ (1.0–15.9 cm³). The median prescription dose for tumor margins was 13 Gy (11–16 Gy). Results: Initial pain control [Barrow Neurological Institute (BNI) grades I–IIIb] was obtained in 10 of 12 patients (83%). However, 3 patients with initial adequate relief later developed pain. Follow-up imaging revealed control of tumor growth in all patients at a median follow-up of 68 months. No patient developed any new sensory dysfunction. The tumor shrinkage was not associated with pain relief. At the final follow-up, 5 patients had pain of BNI grade I (2 after surgery), 4 had grade IIIb and 3 had grade IV. Conclusions: SRS provided effective tumor control, but trigeminal neuralgia persisted to varying degrees in most patients. Multimodality pain management strategies were required in most patients with skull base meningiomas associated with trigeminal neuralgia.

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“…3,18,40,46 Among patients undergoing primary PRGR for classic TN, rates of initial pain relief of between 79% and 92% have been reported, with 50% of patients pain free after 4 years. 7,17,32,35 Among patients with recurrent TN after PRGR who undergo GKRS, repeat PRGR has been reported to be associated with faster pain relief than repeat GKRS (median time to pain relief < 24 hours), but shorter duration of pain relief, greater perioperative morbidity, and a higher failure rate than GKRS. 31,32 One patient in our series underwent PRGR 17 months following the third GKRS.…”

Section: The Effect Of Other Surgical Procedures On Outcomesmentioning

confidence: 99%

The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia

Tempel

Chivukula

Monaco

et al. 2015

JNS

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OBJECT Gamma Knife radiosurgery (GKRS) is the least invasive treatment option for medically refractory, intractable trigeminal neuralgia (TN) and is especially valuable for treating elderly, infirm patients or those on anticoagulation therapy. The authors reviewed pain outcomes and complications in TN patients who required 3 radiosurgical procedures for recurrent or persistent pain. METHODS A retrospective review of all patients who underwent 3 GKRS procedures for TN at 4 participating centers of the North American Gamma Knife Consortium from 1995 to 2012 was performed. The Barrow Neurological Institute (BNI) pain score was used to evaluate pain outcomes. RESULTS Seventeen patients were identified; 7 were male and 10 were female. The mean age at the time of last GKRS was 79.6 years (range 51.2–95.6 years). The TN was Type I in 16 patients and Type II in 1 patient. No patient suffered from multiple sclerosis. Eight patients (47.1%) reported initial complete pain relief (BNI Score I) following their third GKRS and 8 others (47.1%) experienced at least partial relief (BNI Scores II–IIIb). The average time to initial response was 2.9 months following the third GKRS. Although 3 patients (17.6%) developed new facial sensory dysfunction following primary GKRS and 2 patients (11.8%) experienced new or worsening sensory disturbance following the second GKRS, no patient sustained additional sensory disturbances after the third procedure. At a mean follow-up of 22.9 months following the third GKRS, 6 patients (35.3%) reported continued Score I complete pain relief, while 7 others (41.2%) reported pain improvement (BNI Scores II–IIIb). Four patients (23.5%) suffered recurrent TN following the third procedure at a mean interval of 19.1 months. CONCLUSIONS A third GKRS resulted in pain reduction with a low risk of additional complications in most patients with medically refractory and recurrent, intractable TN. In patients unsuitable for other microsurgical or percutaneous strategies, especially those receiving long-term oral anticoagulation or antiplatelet agents, GKRS repeated for a third time was a satisfactory, low risk option.

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Five-and-a-Half Years' Experience with Percutaneous Retrogasserian Glycerol Rhizotomy in Treatment of Trigeminal Neuralgia

Cited by 21 publications

References 13 publications

Technical Difficulties and Perioperative Complications of Retrogasserian Glycerol Rhizotomy for Trigeminal Neuralgia

Technical Difficulties and Perioperative Complications of Retrogasserian Glycerol Rhizotomy for Trigeminal Neuralgia

Stereotactic Radiosurgery for Patients with Trigeminal Neuralgia Associated with Petroclival Meningiomas

The results of a third Gamma Knife procedure for recurrent trigeminal neuralgia

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