Trigeminal Neuralgia

[Maximillian_Jenius]

Doc, you know anything about this afliction?

My mom says she has had it for months. Her neurologist has prescribed many forms of pain killers. They work initially, but after time her body adapts to them and the pain returns.

So, she is looking at the surgery option now. Something about opening up her head and turning her brain. That kinda really scares me, and sounds rather high risk.

Call me being paranoid with Kanye West mother recently passing away. My mother I believe is 59, turning 60 this May. Not a real age difference than Donda West, and I know there are associated risk for older people having surgery and being put under.

I know that everyones body and health condition is different, so it's wrong to compare my moms health to Donda West's. But still freaks me out at the possibility of her having this surgery, and possibly losing her. Are my fears possibly totally irrational?

What do you know about the surgery and the affliction, if any?

Thanks in advance.

[My Flight Surgeon]

I have treated this many times.

Does she live in PHX? Has she seen a neurologist? Has she tried Tegretol, neurontin, Cymbalta? If she has done all of this, the surgery is a good option.

The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that is the source of the pain. Because the success of these procedures depends on damaging the nerve, one side effect is facial numbness of varying degrees.
These procedures include:
Alcohol injection
Alcohol injections under the skin around the branches of the trigeminal nerve may offer temporary relief by numbing the areas for days or months. Because the pain relief is not always permanent, repeated injections may be needed.
Glycerol injection
This procedure is called percutaneous glycerol rhizotomy (PGR); percutaneous means through the skin. A needle is inserted into the trigeminal nerve at the base of the skull where the trigeminal nerve root exits the skull. X-rays are taken to confirm that the needle is in the proper location. Once the location is confirmed, a small amount of sterile glycerol is injected. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals.
Initially, PGR relieves pain in most people. However, pain recurs in many people, and many experience mild facial numbness or tingling.
Balloon compression
In percutaneous balloon compression of the trigeminal nerve (PBCTN), a needle is inserted through the face and into the hole at the base of the skull where the trigeminal nerve exits. Then a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to compress the nerve, thereby blocking the pain signals.
PBCTN successfully controls pain in most people. Most people undergoing PBCTN experience facial numbness of varying degrees, and some patients experience weakness in the muscles used for chewing that is often temporary.
Electric current
Percutaneous stereotactic radiofrequency thermal rhizotomy (PSR) selectively destroys nerve fibers associated with pain. A needle is inserted through the face and into the opening in the skull for the trigeminal nerve. Once the needle is in place, an electrode is threaded through the needle until it rests against the nerve root.
The electrode's position is verified by electrically stimulating the trigeminal nerve. Then a current is passed through the tip of the electrode until it is heated to the desired temperature for about 70 seconds. This damages the nerve fibers and creates an area of injury (lesion). If the pain is not eliminated, additional lesions may be created.
PSR successfully controls pain in most people. A common side effect of this treatment is mild to severe facial numbness. As with the other percutaneous procedures, the pain may recur after months or years, and repeat procedures may be necessary.
Stereotactic radiosurgery
Stereotactic radiosurgery involves delivering single doses of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and eliminates the pain. Stereotactic radiosurgery is successful in eliminating pain more than half of the time. The procedure is painless and typically is done without anesthesia. It may take between three weeks and three months for pain relief to begin. Read more about stereotactic radiosurgery.
Microvascular decompression (MVD)
A procedure called microvascular decompression (MVD) involves relocating or removing blood vessels that have contact with the trigeminal nerve root where it leaves the brain stem. MVD does not damage or destroy part of the trigeminal nerve.
Microvascular decompression is a major surgical procedure done under general anesthesia in the operating room. Commonly, two to three days in the hospital are required after surgery. A small incision is made behind the ear. Then, through a small opening made in the skull, the trigeminal nerve is directly inspected with the aid of a microscope. If the surgeon sees an artery in contact with the nerve root, he or she directs it away from the nerve and places a small Teflon pad between the nerve and the artery to prevent contact with the nerve.
The majority of patients who have this procedure performed by a qualified neurosurgeon have no facial numbness and are pain-free, requiring no further medications. Usually, the pain relief is instant.
While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision and even a stroke or death.

[Maximillian_Jenius]

My mom lives in Tucson, she has what she describes as a very competent neurosurgeon down there. When next I talk to her, I'll ask her her physicians name and ask you if you know him.

Have you heard of the "brain turning" surgery, and what're the associated risk?

As far as I know she has just been on medication like Oxycontin, and the such. So, I'll ask her about the procedures you listed.

Thanks

[My Flight Surgeon]

I have never heard of "brain turning" surgery.

If it were me, I would be seen a Barrow Neurological Institute at St Joseph Hospital. It is world famous and the folks there are top notch. I am pretty picky when it comes to surgery.

[Maximillian_Jenius]

Originally Posted by My Flight Surgeon

I have never heard of "brain turning" surgery.

If it were me, I would be seen a Barrow Neurological Institute at St Joseph Hospital. It is world famous and the folks there are top notch. I am pretty picky when it comes to surgery.

The "brain turning" discription was my mothers. She actually said cerebellum.

In any event her doctor works at Northwest hospital in north Tucson, but I'll tell her about the Barrow Neurological Institute!

[My Flight Surgeon]

A second opinion never hurts.

[Maximillian_Jenius]

Originally Posted by My Flight Surgeon

A second opinion never hurts.

Too right, mate!

[Maximillian_Jenius]

Crisis averted. My mom said that the "brain turning" surgery was for further complications, of another ailment that was fixed with her back surgery, "compression" as she claimed.

She was having some siadic nerve problems associated with her slipped disk.

She says the surgical procedure for Trigeminal Nueralgia is Microvascular decompression (MVD)

She says she is firmilar with all the treatments you mentioned, but said that her doctor spoke of possible side effects as a result.

So she and her doctor feel surgery is now the best option.

Thanks for the help Walt!

[My Flight Surgeon]

Good luck to her Max.