| Restorative Neurosurgery | Trigeminal
Neuralgia
| Normal Pressure
Hydrocephalus
SURGICAL TREATMENTS FOR TN AND RELATED FACIAL
PAIN CONDITIONS
The anatomy of Trigeminal
Neuralgia
While medications provide effective management for many TN patients,
medical therapy is often not a permanent solution for this problem.
Fortunately for the TN patient there are several neurosurgical
procedures that are available if medication no longer provides
the desired results.
The dilemma for the TN patient considering
surgery is how to select a surgical procedure since there are
several modes of surgical intervention available. Procedures
vary from nerve blocks/injections, percutaneous surgery (through
the cheek), to open skull surgery and pinpoint radiation. Each
procedure has certain advantages and disadvantages - ease of
the procedure, effectiveness, long-term results, recurrences,
complications, etc. There is no one medical or surgical treatment
that is effective in all patients. The choice between a procedure
done as a one-day or outpatient (e.g., radiofrequency coagulation
or glycerol injection) or one requiring several days in the hospital
(microvascular decompression) depends on the patient's preference,
physical well-being, previous surgeries, presence of multiple
sclerosis, and area of trigeminal nerve involvement (some procedures
are particularly indicated when theupper/ophthalmic branch is
involved).
Undoubtedly, recommendations by the referring
physician and by the neurosurgeon play a strong part in the patient's
decision-making process. Many physicians are strong proponents
of specific procedures. TNA is not an advocate for any single
mode of treatment, but serves to provide information on the
many treatments available so that TN patients can explore all
their options in an informed partnership with their physician.
* Microvascular Decompression - (MVD). The operation is performed
under general anesthesia where a small opening is made in the
back of the skull on the side with the pain. The trigeminal nerve
is viewed with a microscope and compressing blood vessels are
removed and the nerve is padded with a soft pad (typically shredded
Teflon).
* Stereotactic Radiosurgery - Gamma Knife.
This procedure requires no incision. Using highly focused beams
of radiation, a lesion (an area of controlled damage) is created
in the root of the trigeminal nerve.
The nerve isn't burned
as in a laser treatment, but the radiation causes the slow
formation of a lesion in the nerve over a period of time to interrupt
the pain transmission. Other information links include:
* These procedures show varying degrees of immediate success
and periods of long-term relief from pain. Generally, the average
overall rate of success is 85% with about 25% of this group having
some level of recurrence in 1-5 years. Many patients respond
quite well when additional measures are pursued if the initial
procedure is not successful or if the pain returns. There is
no one procedure that is 100% effective in all cases. Therefore,
it is imperative that the TN patient becomes as informed as possible
about the surgical options available and understands fully the
potential benefits and outcome possibilities of the procedures
being considered.
Restorative Neurosurgery | Trigeminal
Neuralgia | Normal Pressure
Hydrocephalus
For consultation appointments with Dr. Duma
or for more information regarding his brain tumor, GammaKnife
radiosurgery, and Parkinson's Disease programs at Hoag Memorial
Presbyterian Hospital in Newport Beach, California (Orange County),
please contact:
949-642-6787
Or E-mail Dr. Duma directly: drduma@cduma.com
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