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Does Egress of Cerebrospinal Fluid During Percutaneous Retrogasserian Glycerol Rhizotomy Influence Long Term Pain Relief?
  1. Mihir Prakash Pandia, M.D.,
  2. Hari Har Dash, M.D.,
  3. Parmod Kumar Bithal, M.D.,
  4. Rajendra Singh Chouhan, M.D. and
  5. Virendra Jain, M.D.
  1. Department of Neuroanaesthesiology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.


Background and Objectives: To examine the effect of cerebrospinal fluid (CSF) flow during percutaneous retrogasserian glycerol rhizotomy (PRGR) on long term pain relief in patients with trigeminal neuralgia.

Methods: Eighty-nine patients with trigeminal neuralgia underwent 102 PRGR procedures. PRGR was conducted under fluoroscopy. After the egress of CSF, anhydrous glycerol (0.3-0.4 cc) was injected in the sitting position. In the absence of CSF flow, 0.25 mL 2% lidocaine was injected to elicit hypesthesia in the affected side. Once hypesthesia was elicited glycerol was injected. Patients were grouped as A (CSF flow present) or B (CSF flow absent), according to the egress of CSF at the time of needle placement. Patients were followed up for the recurrence of pain (average duration of follow up, 62 months).

Results: CSF flow was present in 54 patients (60.6%) and absent in 35 patients (39.4%). Thirty patients (56.6%) of group A had excellent pain relief, 18 patients (33.3%) had good pain relief, and 6 patients (11.1%) had no pain relief. However, in the absence of CSF flow, 14 patients (40%) each had excellent and good pain relief, and 7 patients (20%) were treatment failures. The pain relief was comparable between the groups. The median time to recurrence of pain needing further injection was 66 months in group A and 63 months in group B (not significant).

Conclusions: Presence of CSF flow during needle placement does not influence the success rate and duration of pain relief following PRGR.

  • Cerebrospinal fluid
  • Glycerol rhizotomy
  • Trigeminal neuralgia

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  • Reprint requests: H.H. Dash, M.D., Department of Neuroanaesthesiology, A.I.I.M.S., New Delhi 110029, India. E-mail: drhh_dash{at}

  • This work was presented, in part, at the 8th Biennial Congress, Asian & Oceanic Society of Regional Anaesthesia, held at Chiba, Japan, December 7-10, 2005.