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Suggest Treatment For Trigeminal Neuralgia

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Posted on Thu, 3 Apr 2014
Question: my mother has severe pain from trigeminal neuralgia. she does not like to take medications and has heard of PBC outpatient treatment. she lives in north east wisconsin. she wants to know a good neurologist to discuss this with. are other less invasive treatments more recommended as well.
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Answered by Dr. S K Mishra (48 minutes later)
Brief Answer: Gamma knife is a new non invasive option Detailed Answer: Hi, Thanks for your query. Initially Trigeminal Neuralgia is treated with drugs. If it does not respond well and MRI shows vascular loop MVD or microsurgical decompression is treatment. However for patients unfit or unwilling for surgery, Gamma knife is a new non invasive option. Radiosurgical (Gamma Knife®) treatment for trigeminal neuralgia is the least invasive option. The Gamma Knife is a device that delivers precise, controlled beams of radiation to targets inside the skull, including the brain and associated nerves. For trigeminal neuralgia treatment, the radiation beams are aimed at the trigeminal nerve where it enters the brainstem. Gamma Knife treatment does not target the root cause of trigeminal neuralgia, but instead damages the trigeminal nerve to stop the transmission of pain signals. The procedure requires little or no anesthesia, and is performed on an outpatient basis. This procedure provides significant pain control or reduction in approximately 80+% of patients, but response is usually slower than for other treatments. Patients usually respond within 4 to 6 weeks post-treatment; however, some patients require as much as 3 to 8 months for the full response. Most patients remain on full doses of medication for at least 3 months after treatment.Side effects may include tingling or numbness in the face (in up to 20% of patients), but this is usually quite mild if it does occur. The percutaneous techniques are all destructive and include radiofrequency thermocoagulation (RFT), balloon compression (BC) and percutaneous glycerol rhizolysis (PGR). In RFT, an electrode inserted through the cheek is used to heat the nerve and cause selective damage to stop pain signals from traveling to the brain. These treatments provides immediate pain relief in up to 90% of patients, but can cause more facial numbness (upto 50%) than the other procedures and has a pain recurrence rate of 40% at 2 to 3 years post-treatment. You can discuss with neurologist in detail pros and cons of different modalities , especially gamma knife (least invasive or non invasive) and choose accordingly. regards,
Above answer was peer-reviewed by : Dr. Raju A.T
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Dr. S K Mishra

Spine Surgeon

Practicing since :1998

Answered : 116 Questions

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Suggest Treatment For Trigeminal Neuralgia

Brief Answer: Gamma knife is a new non invasive option Detailed Answer: Hi, Thanks for your query. Initially Trigeminal Neuralgia is treated with drugs. If it does not respond well and MRI shows vascular loop MVD or microsurgical decompression is treatment. However for patients unfit or unwilling for surgery, Gamma knife is a new non invasive option. Radiosurgical (Gamma Knife®) treatment for trigeminal neuralgia is the least invasive option. The Gamma Knife is a device that delivers precise, controlled beams of radiation to targets inside the skull, including the brain and associated nerves. For trigeminal neuralgia treatment, the radiation beams are aimed at the trigeminal nerve where it enters the brainstem. Gamma Knife treatment does not target the root cause of trigeminal neuralgia, but instead damages the trigeminal nerve to stop the transmission of pain signals. The procedure requires little or no anesthesia, and is performed on an outpatient basis. This procedure provides significant pain control or reduction in approximately 80+% of patients, but response is usually slower than for other treatments. Patients usually respond within 4 to 6 weeks post-treatment; however, some patients require as much as 3 to 8 months for the full response. Most patients remain on full doses of medication for at least 3 months after treatment.Side effects may include tingling or numbness in the face (in up to 20% of patients), but this is usually quite mild if it does occur. The percutaneous techniques are all destructive and include radiofrequency thermocoagulation (RFT), balloon compression (BC) and percutaneous glycerol rhizolysis (PGR). In RFT, an electrode inserted through the cheek is used to heat the nerve and cause selective damage to stop pain signals from traveling to the brain. These treatments provides immediate pain relief in up to 90% of patients, but can cause more facial numbness (upto 50%) than the other procedures and has a pain recurrence rate of 40% at 2 to 3 years post-treatment. You can discuss with neurologist in detail pros and cons of different modalities , especially gamma knife (least invasive or non invasive) and choose accordingly. regards,