Analysis of the Causes of Failure of Percutaneous Retrogasserian Neurolysis with Glycerol for Primary Trigeminal Neuralgia

Objectives To analyze the causes of failure of percutaneous retrogasserian neurolysis with glycerol for trigeminal neuralgia and to make improvement in the neurolysis. Methods From January 1997 to December 2002, 516 percutaneous retrogasserian neurolyses with glycerol were done. The causes of unrelieved trigeminal neuralgia were analyzed in 140 patients whose trigeminal neuralgia was not relieved after the first retrogasserian glycerol neurolysis. Results Of 140 patients with unrelieved trigeminal neuralgia after the first retrogasserian glycerol neurolysis, 91 received the relief of trigeminal neuralgia after the second injection of glycerol, 39 did after the third injection of glycerol and 10 did not after the third injection. The major failure causes included puncture muff, severe vasovagal reactions, the absence of a distinct trigger zone and incomplete analgesia after the procaine test. Conclusions The skilful puncture technique and the proper indication are important to the successful the neurolysis. The painlessness induced by procaine test is essential to complete analgesia after the neruolysis. The percutaneous retrogasserian neurolysis with glycerol is a minimally invasive, safe and effective method of treating trigeminal neuralgia.