Trigeminal nerve peripheral branch phenol/glycerol injections for tic douloureux

Object. Trigeminal neuralgia or tic douloureux is a disease affecting older individuals, and thus, office-based "minimally invasive" therapy is inhere ntly attractive. The author sought to determine whether injection of periph eral trigeminal branches with neurolytic solutions offers a simple, less in vasive therapy, with low risk for patients with one- or two-division trigem inal neuralgia that is unresponsive to pharmacotherapy. Methods. This retrospective study focused on a review of case charts from 1 8 patients treated for tic douloureux. Sixty injections of 10% phenol in gl ycerol were given to the 18 patients, six of whom had undergone other neuro surgical procedures. The median patient age was 74 years, ranging from 36 t o 94 years. There were nine women and nine men. Forty-six injections were a dministered into the infraorbital nerve in its canal in the midface, 11 per cutaneous injections were administered into the mandibular nerve just proxi mal to the mandibular canal in the ramus of the jaw, and three injections w ere administered into supraorbital nerves. Eighty-seven percent of injectio ns brought marked or total relief initially. Of those injections that provi ded initial relief, 37% still provided relief after 1 year and 30% after 2 years, with relief lasting for a median of 9 months after each injection. M ost patients whose pain recurred after months of relief requested a repeate d procedure, rather than undergo a ganglion nerve block procedure or open s urgery. Then were no serious complications or dysesthetic pain. Facial sens ory loss generally recovered within 6 months and was well tolerated. Conclusions. Office-based injection of trigeminal branches is a useful tech nique for neurosurgeons who treat trigeminal neuralgia. It is easily repeat ed and can provide immediate pain relief of intermediate duration.