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Effect of Cerebrospinal Fluid Return on Success Rate of Percutaneous Retrogasserian Glycerol Rhizotomy
  1. Manish Jagia, M.D.,
  2. Parmod K. Bithal, M.D.,
  3. H.H. Dash, M.D.,
  4. Hemanshu Prabhakar, M.D.,
  5. Arvind Chaturvedi, M.D. and
  6. Rajendra S. Chouhan, M.D.
  1. From the Department of Neuroanesthesia, All India Institute of Medical Sciences, New Delhi, India.
  1. Reprint requests: Manish Jagia, M.D., Department of Neuroanesthesia, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. E-mail: jagiamanish{at}


Background and Objective Trigeminal neuralgia is a painful syndrome, which has been commonly treated with percutaneous retrogasserian glycerol rhizotomy (PRGR). This study was performed to evaluate the effect of cerebrospinal fluid (CSF) return on the success rate of PRGR.

Methods In this retrospective, nonrandomized, observational case series, 100 cases underwent 140 PRGRs under fluoroscopic guidance and were followed up for 6 to 36 months. The results were compared in the presence or absence of CSF return before PRGR.

Results The PRGR was successful in 115 procedures (82.1%). CSF return was present in 84 procedures (60%) and, among these, 76 PRGRs (90.5%) produced pain relief. More than 1 year of pain relief without medications was present in 60 of 84 procedures (71.4%). CSF return before PRGR was absent in 56 procedures (40%) and success resulted in 39 procedures (69.6%). Pain relief for more than 1 year without medications was present in 19 procedures (33.9%). The success rate and duration of pain relief was greater in the presence of CSF return compared with absence of CSF return (P ≤ .005). The incidence of complications such as facial dysesthesia (40%), corneal anesthesia (2.8%), herpes simplex (3.5%), and nonbacterial meningitis (0.7%) was not significantly different in 2 groups (P > .05).

Conclusion The presence of CSF is an important factor in determining the success rate and duration of pain relief of PRGR.

  • Cerebrospinal fluid
  • Percutaneous retrogasserian glycerol rhizotomy

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