Glycerol rhizotomy is one treatment option to reduce the pain of trigeminal neuralgia (TN) with an injection (shot) of a chemical called glycerol.
Glycerol rhizotomy is done under sedation (medication to make the patient relax and minimize discomfort). If the patient wants to, he can talk to his doctor during the procedure. The doctor might ask questions about whether the patient's face feels numb.
Guided by imaging technology, the surgeon inserts a specialized needle through the patient's cheek to the area where his trigeminal nerve divides into its three main branches. He or she then directs the needle tip to the division that is causing pain.
Next, the surgeon injects glycerol into the branch. This procedure selectively damages the nerve in order to interfere with the nerve sending pain signals to your brain.
One way that 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. The doctor can do this by the injection of a substance called glycerol into the nerve after they identify the fibers of the nerve using a special x-ray test.
When the doctors do this, they place a small needle through the cheek and direct it through a small opening in the base of the skull where they find the nerve. The doctors will do this with the patient under mild sedation. Once the doctors find the nerve target they inject a very small amount of glycerol, which is designed to inactivate short-circuit of the pain fibers of the nerve.
After the procedure
Glycerol rhizotomy is done on an outpatient basis (no overnight hospital stay). The patient should not eat or drink anything before the procedure. The patient might need someone to take him home afterwards.
What are the Advantages of a Glycerol Rhizotomy?
There are some patients who need to have a non-invasive 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 loss of feeling 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.
Glycerol rhizotomy risks
This procedure is usually safe. However, the patient usually has some numbness in his face. Be sure to talk to the doctor about the potential risks of the patient's particular procedure.