gamma knife or ? for TN?

    
      Re: gamma knife or ? for TN?
    


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Posted by CCF Neuro MD on July 10, 1997 at 15:20:37:

In Reply to: gamma knife or ? for TN? posted by Cynthia Lasley on July 01, 1997 at 13:15:23:

: Hello, I have had trigeminal neuralgia and now anesthesia dolorosa for 5 years.  I
  I had pre-TN for about a year which became full blown TN after a root canal
  was performed 3x on the same tooth.  I was diagnosed by a neurologist with
  atypical trigeminal neuralgia.  After I became allergic to Tegretol (which worked wonderfully)
  I was offered no choice but a glycerol injection.  This was performed and I
  awoke with nausea, headache, numbness of entire right side of my face, and
  a horrible feeling of freezing, including the teeth and eye.  This has since
  been diagnosed as anesthesia dolorosa.  Since going to the pain clinic, they
  have tried stellate ganglia injections, mexilitine, dilantin, elavil, and now
  have settled with the following: Neurontin 300mgs x6 a day, Baclofen 10mgs x6
  a day, Ms-contin 60mgs x 2 a day, Pamelor 30mgs x2 a day, and Percocet, up to 2
  a day if needed.  I still have terrible pain which is only eased by laying down.
  I would like to know if any surgery, like gamma knife or MVD is ruled out?
  Or, what has been offered to me, a computer chip on the pain center controlling
  the right side of my face is warranted.  I have a great fear of ANY surgery
  by now.  Thank you for any help you can give me.
==================================================================================================
Hello, Cynthia,
  Apparently, you have tried several treatment modelities for your condition.  Unfortunately, you were not tolerating tegretol well.  As far as the newer treatments, I was able to find some references on gamma knife.  A recent study published on Journal of Neurosurgery reviewed fifty patients at five centers who underwent radiosurgery with gamma knife and were followed for 18 months (median).  The study reported a 58% patients with excellent control (pain free).  They also pointed out that the proximal trigeminal nerve and root as the entry area is the anatomical target.  However, since this is such a recent advance in technology, long term follow up is warrented.  There were several other studies along the same lines, and results varied to certain degee, but the overal outcome seems quite promising.   As far as other surgical treatment, you mentioned MVD, microvascular decompression.  There was one recent study comparing glycerol injection (GI) and MVD and showed that the recurrence rate in patients treated by MVD is much lower then that by GI, 7% at 95 months and 49% at 84 months, respectively.  
  Regarding the computer chip in the pain center, I was not able to find any references.  However, I don