Journal of neurosurgery
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Journal of neurosurgery · Jul 1986
Randomized Controlled Trial Clinical TrialPercutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia. A prospective study of 100 cases.
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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A retrospective analysis of 76 civilian craniocerebral gunshot wounds treated over a 20-month period is presented. The authors report a 62% mortality rate and conclude that the admission Glasgow Coma Scale (GCS) score is a valuable prognosticator of outcome. Other important findings were: patients with a GCS score of 3 invariably died, with or without surgical intervention; and the presence of intracranial hematomas, ventricular injury, or bihemispheric wounding was associated with a poor outcome. Standardized methods of data reporting should be adopted in order to allow multicenter trials or comparisons that might lead to management practices that could improve results.
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Journal of neurosurgery · Jul 1986
Percutaneous retrogasserian glycerol rhizotomy for treatment of trigeminal neuralgia.
The treatment of trigeminal neuralgia by percutaneous retrogasserian glycerol rhizotomy was assessed in a series of 58 patients with a follow-up period ranging from 2 to 40 months postoperatively. All patients were considered medical failures prior to the procedure. Idiopathic trigeminal neuralgia was the diagnosis in 54 patients, and four patients had trigeminal neuralgia associated with multiple sclerosis. ⋯ The recurrence rate after initial relief of symptoms was 11%. Ten patients (17%) noticed a mild decrease in facial sensation following the procedure, and one additional patient had a profound sensory loss including loss of corneal reflex. The authors conclude that, while percutaneous retrogasserian glycerol rhizotomy may be useful in the treatment of trigeminal neuralgia, more clinical series and documentation of recurrence rate and complications are needed before any firm conclusions can be reached as to the efficacy of this therapy.