Introduction: Trigeminal neuralgia is a devastating neuropathic pain condition. Despite the large variety of treatments currently used, ranging from medications to procedures, many patients continue to suffer from refractory pain. Here we present additional data on a previously published technique involving injection of glycerin into the trigeminal nerve during microvascular decompression surgery (MVD).
Methods: A retrospective chart review was performed for all patients who underwent MVD between August 2008 and October 2016 at this institution. Those who received intra-operative glycerin injection were identified. Demographic characteristics, baseline symptoms, and follow up outcomes were collected and reported.
Results: The study cohort consisted of 36 patients who were treated with intra-operative glycerin. The average age at treatment was 53.4 ± 15.1. There was a female predominance of 69.4%. A total of 16.7% of patients had concurrent multiple sclerosis, and 13.9% of patients had atypical features. Most patients had been conservatively managed with anti-convulsant therapy (97.2%), and 41.7% had other interventions prior to receiving intra-operative glycerin. Overall, 75.0% of patients were found to have vascular contact intra-operatively, compared to 50.0% who had contact on imaging. Venous only contact was found in 44.4% of patients, compared to 19.4% arterial only contact. Intra-operative glycerin injection performed in 97.2% of patients because of insignificant vascular contact or venous contact. The average follow up duration was 8.63 ± 12.5 months. Three (8.3%) were lost to follow-up after surgery. Of those with follow up, all (100%) patients experienced improvement in pain at first follow up, and 75.8% remained pain free at last follow up.
Conclusions: Intra-operative glycerin injection is an effective technique to treat trigeminal neuralgia, resulting in positive outcomes in all patients. However, future studies are needed to determine the relative efficacy of this technique compared to MVD alone.
Patient Care: The study suggests that a novel therapeutic intervention, intra-operative glycerin injection, confers positive outcomes in trigeminal neuralgia patients without significant vascular compression of the trigeminal nerve.
Learning Objectives: 1. Recognize the option of intra-operative glycerin injection for trigeminal neuralgia
2. Understand the indications of selecting this technique
3. Appreciate the positive outcomes of this therapeutic strategy