Treatment of Trigeminal Neuralgia by Thermocoagulation, Glycerolization, and Percutaneous Compression of the Gasserian Ganglion and/or Retrogasserian Rootlets: Long-Term Results and Therapeutic Protocol

Abstract

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.

A prospective study of 39 patients with trigeminal neuralgia treated with percutaneous balloon compression

“…This recurrence rate (20%) indicates recurrence within up to 36 months and is in accordance with other series in the literature 5,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] . It is necessary to emphasize that, in longer follow-up periods, the recurrence rate usually becomes gradually higher.…”

“…However the exact cause of TN remains unclear. When TN occurs in a young patient or when it is bilateral, the presence of demyelinating conditions such as multiple sclerosis should be investigated 5,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] . The goal of PBC is to injure the myelinated fibers that mediate the "trigger" for the lancinating pain of trigeminal neuralgia.…”

Percutaneous balloon compression for the treatment of trigeminal neuralgia: results in 56 patients based on balloon compression pressure monitoring

“…Compression times ranging from 1 to 7 minutes have been reported and sensory loss was subjectively noted to increase with the duration of compression. 12 Although many groups have documented compression pressure, few have consistently monitored amount of compression, duration of compression, and balloon volume. In a recent study, however, researchers held pressure and volume stable while they altered the total duration of balloon compression.…”

Neuralgia del trigémino

“…Posiblemente tiene una incidencia más baja de hipoestesia y anestesia dolorosa que la termocoagulación por radiofrecuencia 31 . Su principal inconveniente estriba en su elevada tasa de recurrencia, ya que a largo plazo menos del 50% de los pacientes tratados disfrutan de una buena analgesia 12 . La repetición del procedimiento incrementa el riesgo de provocar defecto sensorial residual y, por tanto, de disesetesia y anestesia dolorosa.…”

“…El paciente es dado de alta en las 24 horas siguientes si no aparece ninguna complicación. B. Resultados 12,30,33 : se cree que los efectos terapéuticos se deben al daño mecánico y a la isquemia inducidos por el balón sobre las fibras nerviosas y las células ganglionares. El promedio de alivio inmediato es del 89,9% al 100%.…”