Precise Alcoholic Gasserian Injection for Tic Doulourex.
نویسندگان
چکیده
Since October 1954 we have been treating major paroxysmal trigeminal neuralgia (tic douloureux) by precise alcoholic injection of the trigeminal root and ganglion (Ecker and Perl, 1958). To reach the ganglion the needle enters the anterior part of the cheek and proceeds through the foramen ovale. With Penman's (1953) radiographic technique we determine the exact relation of the intracranial tip of the needle to the foramen ovale. We then inject the presumed junction of posterior root and ganglion with minute amounts, each 0 05 ml., of absolute alcohol. Our goal is to produce permanent anaesthesia to light touch in the trigger area of lips and jaws, while sparing corneal sensation as advised by Kugelberg and Lindblom (1959). In most cases, relief of pain has been immediate and has lasted for years (Fig. 1). In cases where, later, anaesthesia disappeared and pain recurred, a second injection was soon requested and promptly brought prolonged relief. We recognize dangers such as corneal anaesthesia with its risk of keratitis, meningitis, and cranial nerve palsies. A few of our early patients have had such complications but the residua are rare and mild. Over an eight-year period, we have managed 133 cases with a total of 173 sessions of injection. We have kept our patients free from severe pain and have produced no permanent serious sequelae and no deaths. Nevertheless, in this paper we emphasize the complications. We began this work in October 1954. Eight years later, in November-December 1962, we carried out a follow-up study of 68 of the 73 patients injected before 23 October 1959. Thus, this is a detailed study of those 68 cases, three to eight years after injection. We also present a summary of the present status of 111 (93%) of 119 patients, a year or more after injection.
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ورودعنوان ژورنال:
- Journal of neurology, neurosurgery, and psychiatry
دوره 28 شماره
صفحات -
تاریخ انتشار 1965