Glycerol Rhizotomy: Technique

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This video reviews technical analysis for performance of a percutaneous glycerol rhizotomy. Glycerol rhizotomy is actually my last preference among percutaneous procedures since it relies upon equals of the CSF through the needle for its completion. I prefer to use a balloon compression rhizotomy as the first choice, since it's more efficient and does not completely rely about CSF egress, that again cannot be reliably achieved in every needle procedure. The patient is placed in a semi sitting position for a glycerol rhizotomy procedure. You can see the position of the patient. I would also like to thank this patient for giving us permission to use her video for teaching purposes. Lateral fluoroscopy is in place. The needle is cannulating into into the foramen using standard techniques as previously described in our previous surgical videos. Oblique fluoroscopy is used to assure the needle is placed among the medial outline of the foramen ovale here. You can see the complete outline of the foramen and the needle tip is placed along the most medial aspect of the foramen. If the needle tip is not along the most medial aspect, the glycerol could potentially be placed or deposited extradurally or in other undesirable locations. After needle is placed, and CSF has been demonstrated to be draining through the needle, I'll go ahead and performed a trigeminal cisternography. Here you can see the cisternogram has been completed, and the contrast has been deposited within the outlines of the trigeminal cistern. I'll go ahead and inject the glycerol as the next step and the patient is kept for in a semi-sitting position for about one to two hours after surgery. Thank you.

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