Percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia: an alternative technique

Abstract

Background: One of the challenges faced by the modern-day NHS is workplace shortages, and experienced radiographers for intra-operative neurosurgical imaging is one such scenario. We describe our method for Percutaneous Retrogasserian Glycerol Rhizotomy (PRGR) using frameless neuronavigation which can be used effectively in such scenarios.Method: Stealth neuronavigation is used for needle placement within the foramen ovale and injection of glycerol, under sedation.Results: In our experience of ten procedures, it is accurate, safe and effective. Good results were obtained on all occasions. It can be repeated as often as necessary using the same Stealth^® CT scan and reduces exposure for staff and patients, where repeated injections are required.Conclusion: This simple modification of PRGR technique is effective and safe provided the surgeon has previous experience in undertaking this procedure.

Keywords: Percutaneous retrogasserian glycerol rhizotomy; glycerol injection; neuronavigation; stereotaxy; trigeminal neuralgia.