Revolutionising Trigeminal Neuralgia Pain Relief using the Modified Kodeeswaran's Retro-gasserian Glycerol Rhizotomy (KRGR) Protocol and Technique in the management of Trigeminal Neuralgia

Objective: To evaluate the Modified Kodeeswaran’s Retro-gasserian Glycerol Rhizotomy (KRGR) protocol and technique of Glycerol Rhizotomy as a preferred treatment option for trigeminal neuralgia, by assessing its efficacy, impact on functional and social disability, psychiatric improvements, hospital stay, complications, and recurrence of pain. While various procedures exist for managing trigeminal neuralgia, evidence on PRGR is limited, particularly regarding its efficacy, safety, and suitability as a minimally invasive day-care procedure. Methods: A prospective study was conducted on 312 patients with trigeminal neuralgia involving the V1/V2/V3 branches. Pain duration ranged from 3 months to 20 years and assessed using World Trigeminal Neuralgia Foundation (WTNF) pain score. All patients underwent radiological evaluation for neurovascular conflict,anatomy and variations of foramen ovale. After informed consent, the modified KRGR was performed. Post-procedure assessments included pain relief, comparison of pre- and post-procedure scores, complications, and improvements in functional, social, and psychiatric status during the immediate and follow-up post-operative periods were noted. Results: Most patients were aged 51–60 years; 56% were female. Left-sided pain (54%) and V2V3 involvement (44%) were most common. 83.7% were medically refractory and 16.3% had recurrent pain (Failed Face Syndrome). Neurovascular conflict was seen in 73.7%. Immediate pain relief seen in 96.15%, and 86% had long-term relief over a 6-year mean follow-up. 17 patients required repeat injections. Minor complications occurred in 11.24% (facial numbness, injection site pain, transient hoarseness, herpes reactivation, facial palsy, and seizures); none were life-threatening. Conclusion: PRGR is a safe, cost-effective, and minimally invasive outpatient procedure with excellent immediate (96.15%) and long-term (86%) pain relief, low recurrence (14%) and a low treatment failure rate (3.85%). Only 11.24% experienced minor complications, along with improved social, functional and psychiatric outcomes post-operatively. Therefore KRGR should be considered a preferred and first-line therapy for trigeminal neuralgia relief.