metrizamide and Trigeminal-Neuralgia

Percutaneous retrogasserian glycerol instillation was performed under local anesthesia for treatment of trigeminal neuralgia in 162 patients. A simplified technique that did not involve cisternography was used. Initial pain relief was achieved in 146 patients (90.1%). Recurrent pain was noted in 27 patients (18.5%) and was more frequent (50%) in patients who had undergone surgical treatments prior to glycerol injection than in those who had no previous surgical treatment (12.3%). A second glycerol injection was carried out in nine patients and a third injection in two patients. The follow-up period extended from 6 to 67 months and 77.8% of patients are totally pain-free after one or more glycerol injections. Another 8.6% experienced good pain relief with the addition of small doses of pharmacological agents. Thus, 140 (86.4%) of the original 162 patients experienced satisfactory pain control following glycerol rhizolysis. Initial sensory loss on the face occurred in 117 patients (71.6%) but at last follow-up examination only 46 patients (28%) experienced mild orofacial hypalgesia and 13 patients (8%) noted analgesia. The corneal reflex was absent in three patients (1.8%) and reduced in five (3.1%). No patients noted corneal ulceration or anesthesia dolorosa. Percutaneous retrogasserian glycerol rhizolysis offers a rapid, safe, reliable, and relatively inexpensive surgical approach to treatment of trigeminal neuralgia.

Topics: Adult; Aged; Aged, 80 and over; Female; Fluoroscopy; Follow-Up Studies; Glycerol; Humans; Injections; Male; Metrizamide; Middle Aged; Pain; Palliative Care; Recurrence; Trigeminal Nerve; Trigeminal Neuralgia

Eleven patients suffering from trigeminal neuralgia were treated by percutaneous glycerol trigeminal rhizolysis after visualization of the trigeminal cistern with metrizamide. In 10 of 11 cases treatment was successful and the pain disappeared. The technique of the treatment is described. This form of treatment is recommended as a successful and simple method, especially in the elderly population suffering from trigeminal neuralgia.

Topics: Glycerol; Humans; Metrizamide; Radiography; Trigeminal Neuralgia

An epidermoid tumor of Meckel's cave was found in a middle-aged woman with trigeminal neuralgia. On CT the lesion had negative attenuation numbers of fat and extended from an expanded Meckel's cave through the porous trigeminus into the ambient and cerebellopontine angle cisterns. Surgical excision provided relief of the patient's trigeminal neuralgia.

Topics: Brain Neoplasms; Carotid Artery, Internal; Dura Mater; Female; Humans; Metrizamide; Middle Aged; Pneumoencephalography; Tomography, X-Ray Computed; Trigeminal Neuralgia

Thirty patients with tic douloureux underwent treatment by percutaneous retrogasserian glycerol injection (PRGI). All patients had symptomatic trigeminal neuralgia refractory to medical therapy. Fifteen patients had recurrent tic after one to four prior operations. The technique was simple to perform and required no intraoperative physiological testing or short-acting barbiturate supplementation during transovale placement of a spinal needle in the trigeminal cistern of Meckel's cave. Precise placement of small volumes (0.15 to 0.35 mL) of sterile glycerol was ensured by first demonstrating the anatomy of the trigeminal cistern using metrizamide. Overall, 23 patients have remained pain free five to 12 months after treatment. Nineteen patients had no change in facial sensation after injection. Treatment by PRGI is a valid alternative therapy for tic douloureux, with the additional benefit of a much-reduced incidence of facial sensory loss when compared with differential thermal rhizotomy by a radiofrequency-induced lesion technique. Facial deafferentation is not mandatory for successful percutaneous treatment of tic douloureux.

Topics: Aged; Female; Glycerol; Humans; Injections; Male; Methods; Metrizamide; Middle Aged; Preoperative Care; Radiography; Recurrence; Skull; Trigeminal Neuralgia

Seventy-five patients with trigeminal neuralgia were treated by the injection of 0.2 to 0.4 ml of glycerol by the anterior percutaneous route into the trigeminal cistern, which was visualized by the aid of contrast medium (metrizamide). Eighty-six per cent of the patients were completely free from pain after the treatment, which produced only minimal disturbance of facial sensitivity. No complications have been observed. It is suggested that glycerol acts mainly on partly demyelinated nerve fibers, which are assumed to be involved in the trigger mechanism.

Topics: Aged; Glycerol; Humans; Injections; Metrizamide; Radiography; Sensation; Trigeminal Nerve; Trigeminal Neuralgia