Comparative Evaluation of Percutaneous Retrogasserian Glycerol Rhizolysis and Radiofrequency Thermocoagulation Techniques in the Management of Trigeminal Neuralgia

BACKGROUND: Among the percutaneous procedures for the treatment of trigeminal neuralgia, percutaneous anhydrous glycerol rhizolysis (PRGR) and radiofrequency (RF) ablation of trigeminal neuralgia have stood the test of time. OBJECTIVE: A prospective study was conducted to compare PRGR and RF ablation techniques in patients with trigeminal neuralgia in terms of (1) efficacy of pain relief, (2) duration of pain relief and (3) side effects. METHODS: All patients presenting to our pain clinic for the first time for the treatment of trigeminal neuralgia were enrolled to receive either PRGR or RF ablation; the treatment was chosen by the patient. Demographic data, magnetic resonance imaging scan, relevant medical disease, amount of anhydrous glycerol, lesion temperature, and total duration of RF were noted. The presence or absence of cerebrospinal fluid egress, immediate pain relief, duration of pain-free period, need for repeat injection or additional peripheral nerve block, and recurrence of pain were also noted. The degree of pain relief was recorded every 3 months. Any complications during the procedure and side effects were also recorded. RESULTS: Seventy-nine patients underwent either PRGR (n = 40) or RF thermocoagulation (n = 39). A total of 23 patients (58.9%) in the PRGR group and 33 patients (84.6%) in the RF group experienced excellent pain relief. The mean duration of excellent pain relief in the PRGR and RF groups was comparable. By the end of the study period, 39.1% patients in the PRGR group and 51.5% patients in the RF group experienced recurrence of pain. CONCLUSION: Both PRGR and RF techniques can achieve acceptable pain relief with minimal side effects.

Glycerol neurolysis: neurophysiological effects of topical glycerol application on rat saphenous nerve

✓ The effect of topical glycerol application on normal and previously injured saphenous nerves was tested in 20 Sprague-Dawley rats. Anhydrous glycerol treatment of five normal nerves showed a rapid loss of C-fiber conduction within 5 minutes of application, while after 10 to 30 minutes, a complete conduction blockade in all fiber types was produced. The effect of anhydrous glycerol on both spontaneous firing from the neuroma and impulse propagation within the nerve was examined in 11 rats that had undergone saphenous neurotomy 7 days previously. In these animals, cessation of spontaneous action potential production from the neuroma was the earliest electrophysiological change noted, followed by loss first of C-fiber, then of A-fiber conduction. Graded concentrations of glycerol (25%, 50%, 75%, and 100%) were used in four rats with saphenous neuromas, which allowed selective blockade of spontaneous action potential generation and C-fiber conduction with minimal effect on A-fibers. The neurophysiological mechanism of glycerol neurolysis appears to be a nonspecific conduction blockade of large and small fibers, which is established within minutes of its application. Spontaneous firing within damaged axons, which may play a role in a variety of cranial and peripheral nerve sensorimotor syndromes, is also exquisitely sensitive to glycerol application.