Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Question Title: TN related

Forum: Neurology Forum
Topic: Neuralgia


I was diagnosed with Typical TN 6 yrs ago. It comes as sharp jolts of pain on the left side of my face. I took tegretol and it stopped the pain but
but I had a bad reaction to it and had to stop. Its been getting worse
and more frequent as time passes. I had numerous nerve blocks done by a pain clinic with little sucess. I saw an oral surgeon and discussed
the possibility of it being NICO. He saw nothing on the Xrays but because of my insistance agreed to explore the area. He found a large cavity in the bone of my jaw and cleaned it. The pain persisted and he went back to make sure he go it all. He then recommended exposing the nerve and putting alcohol on it kill it. This was done and 2 weeks later the pain was completely gone for 6 months. When it started again I had him repeat the procedure and after 2 weeks the pain was gone for 5 months. I had the procedure repeated twice again with no results. I considered having a neurectomy done, but after consulting with a Neurosurgeon specialing Brain Stem surgery decided on an MVD first.

I had a recent MRI to rule out MS, and had the MVD done. My Surgeon found 2 veins growing through the nerve and was confident he got all compressions. Its been a three weeks and the TN pain returned and is getting worse as time passes.

I am be meeting with my surgeon to discuss where I go from here.
I was wondering what your thoughts were on possible options.


____

Dear TJ;

Obviously the first thing to do is to talk to your neurosurgeon first.
He might elect to re-explore the MVD site and it may require further
decpomression.

If this fails then there are other options that may or may not work. These
include Gamma Knife surgery to the Trigeminal Nerve, Surgical sectioning
of the trigeminal nerve and/or peripheral neurectomy as well as glycerol
rhizotomy or RF rhizotomy.

I do think that you should discuss this with your neurosurgeon before
making any further decisions on this issue.

Good Luck!




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