Retrogasserian Glycerol Injection as Treatment of Tic Doulouruex: Report of twelve cases

Park, Wook; Hwang, Kyung Ho; Kim, Yon Ik; Kim, Il Ho; Song, Hoo Bim; Kim, Sung Yell

Abstract

In 1983, Sten Hakanson first reported the clinical safety and efficacy of retrogasserian glycerol injection as a treatment of typical trigeminal neuralgia in 96 of l00 patients during a follow-up period of 1-6 years. Since September 1987, we have injected sterile pure glycerol into the trigeminal cistern using an anterior percutaneous approach via the foramen ovale (Hartel Route) for treatment of tic douloureux in 12 patients who were suffering from attacks pain of following discontinuation of carbamazepine. The results were as follows; 1) Eight patients were completely free from pain attacks with a single dose of glycerol (0.4 ml). The remaining four patients needed a second dose (0.4 ml) several days later following the single dose. The degree of patient's subjective satisfaction by those injections was very good in 11 and fair in one. 2) During the follow-up period (1-13 months), persistent sensory deficit as determined by the pin prick test, appeared to be mild in 10 and moderate in one patient. There was no sensory deficit in one patient. further attacks of pain from those injections were still noted. 3) As a transient complication, there was headache in all patient, facial hematoma in 4, nausea and vomiting in two each, and vertigo and herpes simplex in one each. In conclusion, we confirmed that the above glycerol injections into the trigeminal cistern were clinically very effective as a treatment of tic douloureux even though the follow-up period was short.