What is the role of PRGR in the treatment of trigeminal neuralgia (TN)?

Updated: Sep 30, 2019
  • Author: Kim J Burchiel, MD, FACS; Chief Editor: Brian H Kopell, MD  more...
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Answer

Answer

Glycerol injection of the gasserian ganglion to destroy the pain-transmitting fibers has been used for a long time. It is easy to perform and has a higher efficacy rate and a lower recurrence rate than alcohol injection.

In PRGR, as in other percutaneous procedures, a spinal needle penetrates the face, this time to the trigeminal cistern, at which point a cisternogram is obtained with water-soluble contrast material. After removing this material, the surgeon instills anhydrous glycerol, asking the patient to remain seated for an additional 2 hours until the nerve is fully ablated.

In the view of some, PRGR is the favored procedure, in that it includes only a minimal risk of disturbed facial sensitivity postoperatively. However, Cappiabianca et al [12] and Taha and Tew, [13] who favor the radiofrequency rhizotomy, argue that PRGR has the highest rate of pain recurrence.


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