A new Mayo Clinic study found that posterior fossa exploration surgery provided significantly better pain relief than stereotactic radiosurgery for patients with trigeminal neuralgia. This study was presented at the American Association of Neurological Surgeons Annual Meeting in San Diego on May 5, 2009.
Trigeminal neuralgia is characterized by episodes of intense, stabbing, electric-shocklike pain in areas of the face which have branches of the trigeminal nerve (lips, eyes, nose, scalp, forehead, upper jaw and lower jaw). The trigeminal nerve carries sensation from the face to the brain. In trigeminal neuralgia, the nerve function is disrupted. Approximately 15,000 patients are diagnosed with trigeminal neuralgia each year in the U.S.
“Medical therapy eliminates or significantly reduces the pain for 75 percent of patients with trigeminal neuralgia, but the effectiveness generally decreases over time and surgery becomes necessary for patients to maintain their quality of life,” says Bruce Pollock, M.D., a neurosurgeon at Mayo Clinic and the lead author of this study. “In posterior fossa exploration surgery, the hope is to find a blood vessel pushing onto the trigeminal nerve that can be moved or displaced. We consider this to be the gold standard of trigeminal neuralgia surgeries. Stereotactic radiosurgery, on the other hand, directs radiation onto the nerve with the hope of creating a mild degree of damage to relieve patients of facial pain.”
Dr. Pollock and his team reviewed the records of 149 patients who had posterior fossa exploration surgery or stereotactic radiosurgery for trigeminal neuralgia between June 2001 and September 2007. Prior to surgery, patients were informed that posterior fossa exploration surgery was most likely to relieve facial pain without causing numbness. Sixty-one percent of patients chose to undergo posterior fossa exploration, while 39 percent opted for stereotactic radiosurgery.
The researchers found that patients who had posterior fossa exploration were more than two times more likely to achieve and maintain pain relief without the need for medications. Additionally, posterior fossa exploration surgery was found to be safe, and the incidence of facial numbness was much lower after posterior fossa exploration surgery than after stereotactic radiosurgery.
Below is a link to an edited youtube video with Dr. Pollock .
2 Comments
I’m a 51 year old woman and have been suffering miserably with the intolerable pain symptoms of Trigeminal Neuralgia in my lower right jaw. I also have a Perotid mass growing in front of my right ear. After having root canals in nearly all of my teeth, a molar extraction, a bite plate made for the potential of TMJ – none of which provided any relief, my dentist finally recommended I see an Endodontist… who referred me to an ENT and/or Neurologist. I just saw an ENT who ordered a CT Scan, is the one who identified the very obvious Parotid tumor and told me it must be removed. He claims he has performed more than 400 of this type of surgery … But my concern is that he did NOT acknowledge the association with my Trigeminal Neurology symptoms nor whether the removal of the tumor would relieve my pain. Is it that he wouldn’t know until he sees the results of the CT scan or actually got inside and was able to identify if the tumor was the cause, OR should I be concerned that he isn’t the right kind of doctor for my particular case?? I’ve lost a lot of weight (which I can’t afford to lose – I’m 5′4″ and down to 105 lbs) because I’m terrified of the pain when I eat, I can barely get through brushing my teeth or washing my face, and sometimes am unable to finish a sentence without having an “attack.” BUT, here’s a strange twist that I’ve never heard of with either of these two “conditions”: Sometimes certain foods will trigger an attack “on contact” in my mouth BEFORE I even chew. Could this be a saliva gland reaction/trigger since they all somehow seem to be related? This is the one symptom that appears to be unique to my situation. It’s difficult to find reliable facts from cases I’ve read about on the Internet, so I’m frustrated, scared, angry, depressed and to make matters worse or shall I say seemingly hopeless, I do not have health or dental insurance. Where does one turn under these circumstances and hope to get the best care necessary?
Thank you for your comment. It has been forwarded to the doctor’s attention.