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Trigeminal neuralgia
is not exactly a disease. It is a condition,
a unfortunate condition because a
it's a terrible pain the patient has to suffer.
For trigeminal neuralgia, gamma knife is very effective
in relieving significant pain that people have for which they're on
multiple medications, often times for you know 10-20 years
so it's very gratifying for the patients to go through a single procedure and
then a few weeks later
have resolution for this pain they've had for many years. When a patient comes with
trigeminal neuralgia,
we a can offer three different
treatments. I offer the Gamma Knife as a first
option because it is obviously less
risky and has a less chances of
side effects and complications than others.
The most common open surgical approach is a procedure called the microvascular
decompression
in which a very tiny
sponge is placed between the fifth cranial nerve
and any adjacent blood vessels. That's a
procedure that requires going to the operating room for an open procedure.
With gamma knife we deliver a
very focused tiny, high-dose
of radiation to the fifth cranial nerve as it
exits the brainstem. So isolating that area is very important
and staying away from the other cranial nerves that also exit the brain stem
is also very important.
Essentially what we're doing is scarring down the nerve
or its electrical conductivity so that those pulses that are causing such
severe pain
for our patients is kind of dulled and in that
sense they have
an improvement in their pain and often an improvement in their quality of life.
When treat a trigeminal neuralgia,
I always tell the patients that we have a
time frame that we have to wait
to evaluate if the treatment has been
successful or not. The average time to pain relief is approximately one month
however patients can have improvement as soon as
24 to 48 hours after the procedure. It's hard for us to predict up front who is
going to respond more quickly
we do know that patients who have had trigeminal neuralgia and
and have a period of response
say five to ten years and then get retreated often have a lesser
degree in response later, say about 70 percent
compared to the first timers who have an eighty to ninety percent improvement in
pain
So my first line of treatment for trigeminal neuralgia today is Gamma Knife.
We think it's
extremely useful,
valuable and
patient-friendly.