UK TRIGEMINAL NEURALGIA ASSOCIATION

 

Main contact                                                                                                                       

 

Elisabeth BOULOT                                                                                                             

248, Cottesmore Gardens                                                                                                     

London, W8 5PR                                                                                                                 

mailto:eboulot@tna-uk.org.uk                                                                                                    

                                                                                                                                               

 

TNAssociation (USA) web-site: http://www.tna-support.org

 

 

CONSIDERING SURGERY FOR TN

 

There are no relevant studies to clearly define when it is time to move on from medication to surgery. Practically, it is either when medications are not working anymore, or when side effects become intolerable. It is a patient's choice, and it has to be discussed with a neurosurgeon.

Prior to a surgery, you may be asked to have an MRI or MRA. It will help the neurosurgeon to see if there is a possible cause to your TN pain.

There are different types of surgical options. Here is a very brief summary on each possibility, their advantages and disadvantages.

 

 

Microvascular Decompression (MVD)

 

This is considered as a major surgery. An opening is made on the back of the head, just behind the ear. The skull is then opened with a drill, and a microscope is brought in for observation. The surgeon carefully removes all blood vessels and arteries compressing the nerve, and introduce little pads along the nerve to protect it. The stay in hospital is about a week.

 

 

Peripheral procedures

 

When TN affects one of the multiple branches, minor surgeries are available. A needle is passed through the cheek, to reach the area of pain. The surgeon can:

- heat the branch (Radiofrequency Rhizotomy)

- inject a substance which gradually destroys the branch (Glycerol injection)

- inject a substance which will freeze the branch (Cryosurgery)

- compress the branch with a small balloon (Balloon compression)

 

When TN affects one or more full division of the nerve, the same minor surgeries are available, but the surgeon will pass the needle through the cheek, through a little hole in the skull to reach the ganglion, and the procedure will affect the whole division of the nerve.

Whatever the procedure damages the nerve, and replaces the pain by numbness. These are rather simple interventions, and only necessitate a few hours stay at the hospital.

 

 

Gamma Knife

 

We can also add to that list a fairly new procedure called GAMMA KNIFE. This technique uses radiation beams targeted with precision. It is obviously very attractive for  the patient as it is non-invasive, painless and requires no anaesthesia. But there is no study yet on the long outcome of this procedure, and very few hospitals carry it.

CONSIDERING SURGERY FOR TN

 

Comparing the different procedures

 

MVD

 

Disadvantages:

major surgery, and therefore complications may occur, including hearing loss, dizziness or death (less than 1%).

 

Advantages:

Numbness is very unusual. The effect of the surgery is longer : after 5 year, 75% of the patients are still free of pain.

 

 

Peripheral procedures

 

Disadvantages:

It always causes some numbness, and the degree of numbness is impossible to predict. The effectiveness on the pain is shorter than with an MVD : the average is 1 to 2 years. Some people will have a relief for a few days, some for 5 or 6 years… Once again, it is unpredictable.

 

Advantages:

It nearly always work with classical TN, and can be repeated. The hospital stay is minimum. Very few risks : less than 1% get a severe complication.

 

 

Conclusion

 

It is still very difficult to decide on one or other surgical procedure because we need more accurate figures to be able to make the right decision.

There is a common pattern for treatment advice: neurosurgeons usually recommend an MVD for young and fit patients, and one of the peripheral procedure for older ones. However, if an old patient is fit enough, he could certainly have an MVD.

 

The most important is to be sure to have been given the correct diagnosis :

Do I really have TN, and not any other facial pain?

Once this is clear, then you can move on :

- Do I have all procedures available to me? It is important to have the choice.

- Do I have good advice ?

- Do I have enough information to be able to compare the efficacy of all treatments ?

- Am I prepared to deal with all possible side effects ?

_____________________

 

The best person to talk to is your neurosurgeon. You can ask him about his experience on the surgery you are considering, and what is his success rate. It is also useful to talk to other patients who had have surgery. There is no such specification right now in our contact list, but little by little, we are gathering this information from everybody. So as soon as we have it all, I shall print a new and more useful list! If you need to talk to someone now, just contact me or Steve Pattenden and we shall look into our files.

 

This document has been prepared according to the review given by Mr Peter Hamlyn, Neurosurgeon, during our first TN meeting

in London on June 21st 1999.