Long Island Neurosurgical & Spinal Associates (LINSA)
Pain Alleviation

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 Trigeminal Neuralgia (Tic Douloureux)
Description
Facial pain is one of the most distressing neurological symptoms. The causes are numerous and   extremely varied. The evaluation of a patient with facial pain requires a careful, thorough history and examination by a physician with experience in this area. True Trigeminal Neuralgia (TNG) can be extremely disabling
Cause
One of the major causes is thought to be vascular compression at the root entry zone of the trigeminal nerve. Tumor and multiple sclerosis are also important causes. Most patients initially respond to medical management with carbamazepine (Tegretol), phenytoin (Dilantin), and lioresal (Baclofen). However, unacceptable long-term side effects and suboptimal pain relief despite dose augmentation over time are indications for surgical consultation
 
Treatment

Trigeminal neuralgia can be treated successfully through microvascular decompression, which is a relatively safe and novel technique popularized by Dr. Peter Jannetta. The concept of surgery was developed from information that an abnormal vessel (or a vessel in an abnormal location) in the vicinity of the 5th cranial nerve, due to its constant and continuous pulsations, produces pressure on the nerve, resulting in excruciating pain. In the technique of microvascular decompression, the vessel is mobilized and separated from the nerve with a Teflon felt. In this way, the vessel is prevented from transmitting its pulsations to the nerve. The cure rate with this procedure is higher than with other procedures such as glycerol injection and radiofrequency lesioning. Pain relief is immediate and permanent in 70%-75% of the cases. The side effects, such as anesthesia dolorosa, are virtually nil. Serious complications such as cranial nerve palsies or cerebellar infacts have been reported, but are very rare

GammaKnife Radiosurgery
More recently GammaKnife radiotherapy has become an important tool in treating TGN, especially in older patients and less typical facial pain syndromes

 

Other procedures
Gasserion ganglion rhizolysis with glycerol or radiofrequency techniques