[Experience with retrogasserian glycerol rhizotomy in the treatment of trigeminal neuralgia.].

From August 1981 to May 1993 a total of 1263 percutaneous retrogasserian glycerol rhizotomies after Hakanson were performed. The intervention was performed with X-ray monitoring under local anaesthesia and rarely lasted longer than 20 min. It achieved good results in the treatment of idiopathic trigeminal neuralgia (TN) and symptomatic trigeminal neuralgia due to multiple sclerosis (TNMS). Some 97% of the TN patients were completely free of pain after the intervention. The recurrence rate within 5 years was 12.8%. Some 94.7% of the TNMS patients were immediately free of pain, but within 2-5 years they experienced a high recurrence rate of 40.2%. The results in the patients with atypical facial pain were more disappointing: only 66.6% were pain-free immediately after the intervention, and the recurrence rate was 31%. With respect to the side effects immediately postoperatively, herpetic eruptions were found in 43.2% of cases. They occurred on the 3rd postoperative day and persisted for 2-3 weeks before being relieved by local virostatic therapy. Hypaesthesia and hypalgesia were present in the early postoperative follow-up in half of our patients. Both these reductions of sensitivity have a tendency to regress. Later, after 2 years, there was reduction in sensitivity of this type in only 20% of cases. In the follow-up 17.5% of our patients complained of dysaesthesia and in 21.4% corneal sensitivity was reduced or lost. We believe that glycerol rhizotomy, owing to its effectiveness, easy applicability, slight distress for the patients and low side effects, should be recommended as a first measure for non-conservative treatment of idiopathic trigeminal neuralgia as well as trigeminal neuralgia in multiple sclerosis.