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Trigeminal Neuralgia
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Trigeminal neuralgia is an uncommon affliction characterized by extreme unilateral facial pain. The etiology or cause of trigeminal neuralgia is unknown but results in an abnormal stimulation of the 5th cranial nerve (a.k.a. the trigeminal nerve) causing the brain to perceive intense pain of short duration (on the order of minutes). These spells of intense facial pain can occur frequently throughout the day and may be brought on or "triggered" by common everyday functions or experiences such as chewing, touching the face, or putting on make-up. Needless to say, the condition may be debilitating and extremely problematic. Evaluation and treatment for trigeminal neuralgia starts with insuring that there is no identifiable cause for the pain, such as a tumor along the course of the nerve. Drugs such as carbamazepine (Tegretol) and pain medicines are used as first line therapy for trigeminal neuralgia. When patients fail to respond or become intolerant to these more conservative measures, they may be considered for injections, radiofrequency treatments, microsurgery, or Gamma Knife radiosurgery. The experience with Gamma Knife radiosurgery for the treatment of trigeminal neuralgia continues to grow with over 500 patients treated according to the manufacturer's data. Our center, as well as several others, targets a high radiation dose precisely at the root entry zone of the 5th cranial nerve as it exits the brainstem. Published experience is limited, but indicates that around 40% of patient's will get some meaningful relief of pain, 40% will get complete or nearly complete relief of pain, and 20% will see no benefit. The median time to improvement in those who respond is around 4-6 weeks from the day of the procedure. Side effects may include temporary or permanent numbness on the face of the affected side, although this side effect has been rarely observed. Overall, the experience with the Gamma Knife compares favorably with other second line treatments for trigeminal neuralgia. It remains to be seen if the pain relief from Gamma Knife radiosurgery will be long-lasting, but some responders have been followed for years without recurrence of pain. [Keywords: unilateral facial pain, Trigeminal Neuralgia, trigeminal nerve] |
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