Percutaneous retrogasserian glycerol rhizotomy for tic douloureux: Part 1. Technique and results in 112 patients.

The technique and results of treatment of tic douloureux by percutaneous retrogasserian glycerol rhizotomy ( PRGR ) were assessed in a series of 112 patients. All patients were refractory to or intolerant of medical therapy. Many of these patients had recurrent pain despite such surgical treatment as microvascular decompression (21%) or one or more percutaneous radiofrequency thermal rhizotomies (19%). The follow-up duration after glycerol rhizotomy ranged from 4 to 28 months. At the final assessment, 67% had complete pain relief; 23% were improved, with pan relieved by minimal drug therapy; and 10% had poor results with unsatisfactory pain relief even with medications. Before the final assessment, 19 patients required a second PRGR because of an initially suboptimal injection (10%) or recurrent pain (16.9%). Seventy-three per cent had no demonstrable change in facial sensation after operation. H akanson 's original procedure based on anatomic verification by cisternography provided precise localization, required no intraoperative stimulation or lesion generators, and allowed varied anesthetic options during operation. In contrast to thermal rhizotomy, PRGR offers patients relief of painful tic douloureux without altering facial sensation in most cases.