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Glycerol Rhizotomy for Trigeminal Neuralgia

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On Topic Video Transcript

L. Dade Lunsford, MD

Director, Center for Image-Guided Neurosurgery

Trigeminal neuralgia is a facial pain syndrome characterized by sharp stabbing or electrical pain usually in the lower part of one side of the face. It can be difficult to control by medicine and while we do have a number of surgical options for this, we sometimes need to have a procedure which is very quick in action.

What is a Glycerol Rhizotomy?

One way that we can change the flow of pain information through the trigeminal nerve is to try to eliminate some of the fibers of the nerve that are short-circuiting. We can do this by the injection of a substance called glycerol into the nerve after we identify the fibers of the nerve using a special x-ray test. When we do this we place a small needle through the cheek and we direct it through a small opening in the base of the skull where we find the nerve. We do this with the patient under mild sedation. Once we find the nerve target we inject a very small amount of glycerol, which is designed to inactivate the short-circuit of the pain fibers of the nerve.

What are the Advantages of a Glycerol Rhizotomy?

There are some patients who need to have a noninvasive but rapid action procedure, that is one where the effect of pain relief can be obtained in a matter of a day or so. The advantage of the glycerol procedure is that it is less invasive and that the mechanism of pain relief is usually relatively quick in terms of onset, often in a mere 12 to 24 hours. And in patients who have really severe pain where they are not able to eat or chew or talk we need to have a technique to be able to rapidly lead to pain relief, and that’s one of the advantages. The second advantage is that this procedure has a relatively low risk of causing any feeling loss in the face. So our twin goal is to not only obtain pain relief but also to not do so at the expense of a lot of long-term numbness of the face.

Experience and Expertise

At UPMC we first did a glycerol procedure in 1981 and since that time we have performed this procedure more than 1,500 times. That experience and our commitment to finding out the best way to do it and to be able to get the best relief is done based on our experience over these 25 years now.

For more information, please call (412) 647-7744, or visit the Center for Image-Guided Neurosurgery at the University of Pittsburgh website.