1281. Retrosigmoid approach for glycerin rhizotomy for the treatment of trigeminal neuralgia without overt arterial compression: updated case series

Authors: Timothy Kim; Christopher Jackson; Yuanxian Xia; Leila Mashouf; Kisha Patel; Eileen Kim; Tomas Garzon-Muvdi; Matthew Bender; Chetan Bettegowda; John Lee; Michael Lim (Baltimore, MD)

Introduction: Trigeminal neuralgia (TN) is a neuropathic pain disorder characterized by severe, lancinating facial pain that is commonly treated with neuropathic medication, percutaneous rhizotomy, and/or microvascular decompression (MVD). Patients who are not found to have distinct arterial compression during MVD present a management challenge. In 2013, we reported a small case series of such patients treated with intra-operative glycerin injection into the cisternal segment of the trigeminal nerve. The objective of the present study is to report our updated experience with this technique to further validate this novel approach. Methods: We performed a retrospective analysis of patients who had an injection of glycerin directly into the inferior third of the cisternal portion of the trigeminal nerve. Seventy-four patients, including the 14 patients included in our prior study, were identified and demographic information, intraoperative findings, post-operative course, and complications were recorded. Fisher’s exact test and unpaired t-tests were used to compare with a cohort of 476 patients who received standard microvascular decompression by the same surgeon. Results: 74 MVD + glycerin cases were identified. They had an average follow-up of 19.1 ± 18.0 months and a male-to-female ratio of 1:2.9. 33 patients (44.6%) had previously failed intervention for TN. On average, patients had an improvement in the Barrow Neurological Institute pain intensity score from 4.1 ± 0.4 pre-surgery to 2.1 ± 1.2 post-surgery. 95.9% of patients experienced pain improvement after the surgery. 5 patients developed complications (6.7%) including incisional infection, facial palsy, CSF leak, and hearing deficit, all of which were minor. Conclusion: Intra-operative injection of glycerin into the trigeminal nerve is a safe and effective treatment for trigeminal neuralgia when no distinct site of arterial compression is identified during surgery, or decompression of the nerve is felt to be inadequate.