K. Singh Sahni, M.D., F.A.C.S.
Neurosurgical Associates, P.C., Richmond, VA
10710 Midlothian Turnpike, Suite 138
Richmond, VA 23235
804-330-4990
http://www.trigeminalneuralgiava.com/dr-sahni.htm
Transcript: Glycerol procedure
Glycerol procedure for patients with trigeminal neuralgia was first reported probably in the early 80’s in Europe and it was rather accidentally discovered. One of the neurosurgeons who was actually trying to do radiosurgery was using glycerol as a vehicle to carry and get x-rays. And he noticed that before he even did the procedure, a lot of patients were already getting better. And then it’s been reported after that in several different papers. And I’ve been using glycerol injections since 1983.
And the procedure is rather very straight-forward and as a matter of fact, it has changed over the years. Right now, all of the patients that we do glycerol injections on are out patients. They come in, they get the procedure done, and they go home the same day.
Basically what’s done is in the operating room. The patient is heavily sedated to the point that the patient does not remember the procedure at all. That’s a bigger difference between glycerol and radiofrequency. In radiofrequency procedures, you have to have the patient awake enough that during the procedure you have to check and talk to the patient so the patient has to communicate back with you. With glycerol injections, that is not the case. So you don’t have to wake up the patient.
Basically, the patient is heavily sedated. The needle is inserted with a fluoroscopy, an x-ray machine. You have a specific target. And I heavily, heavily rely on a contrast medium that I inject. I give this contrast which is a dye and I find out how big is that cistern. Cistern being the fluid, the spinal fluid surrounding the nerve. It is very important to do that.
A big difference between the radiofrequency procedures and this is the volume of the cistern is important because the results of the glycerol injection are very much dependent on the amount of glycerol you give. We almost give as little as maybe .3 to .5 cc’s which is a very, very low dose. That’s half a cc or less probably sometimes a quarter cc. And if you don’t measure that volume accurately and you give a higher volume of glycerol, you will increase incidence of numbness. So that’s very important. Again, technically it’s the finesse that for these procedures it has to be done by surgeons like any of the other procedures that are done - very heavy volume so that you have a pattern to that.
The procedure in my hands takes about ten to fifteen minutes. And after the procedure is done, they have to sit in the recovery room. I make them sit for two hours with their chin flexed and head turned to the side that I injected. Now, a lot of my patients ask me what’s going on and the laymen terms I use for them unfortunately is that we are marinating the nerve. Basically, the glycerol has to stay there, covering the nerve for the very short period of time and excellent results are seen when you go through this entire procedure, step by step. After the two hours that they’ve been in the recovery room usually they’re awake enough and they go home about an hour later.