A new surgery helping people find pain relief

Merelia spent years trying to figure out what was happening to her.

For two years, off and on, sharp pains stabbed Merelia's face, until finally, she was diagnosed with Trigeminal Neuralgia.

Trigeminal Neuralgia is a short circuit in the Trigeminal Nerve.  140-thousand nerve fibers make up the Trigeminal Nerve. 

Most of them send normal messages to the brain, like when something touches your face, but many of those fibers only send pain messages. 

Each nerve is insulated, but when that insulation is damaged, the pain nerves can be activated.

Abe was misdiagnosed by doctors and dentists for seven years.

Abe's medical mystery ended when he found St. Lukes-Roosevelt Hospital Neurosurgeon Robert Goodman.

The idea is to actually cure Trigeminal Neuralgia with microvascular decompression surgery.

To the right of the nerve is the basilar artery, which is pushing on it and causing the pain.

Doctor Goodman made a small opening in the bone behind the ear and was able to move the artery and blood vessels away from the nerve.

He inserted a shredded teflon felt and sponge material that prevents it from touching the nerve -- giving it a cushion, so it can't press against it again.

Merelia had the surgery two days before and now she feels no pain.

For 90 percent of other patients it's a cure.

More information on next page.

BACKGROUND: Trigeminal neuralgia is the most common craniofacial pain syndrome. This chronic pain condition affects the trigeminal nerve. People affected may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. Trigeminal neuralgia affects women more often than men, and it's more likely to occur in people who are older than 50. Trigeminal neuralgia may run in families.
(Source: Columbia University Medical Center, Department of Neurological Surgery)

CAUSES: Doctors aren't exactly sure what causes trigeminal neuralgia. However, there is considerable evidence that vascular compression of the trigeminal nerve near the brainstem is the cause. This may be due to branches of the superior cerebellar artery, basilar artery, or local veins compressing the trigeminal nerve. Additionally, trigeminal neuralgia can be caused by tumors in the region of cranial nerve V or by multiple sclerosis.

SYMPTOMS: Trigeminal neuralgia pain is classically described as "stabbing" or "electrical shock-like." Episodes are usually brief, lasting a second or two, but can be unbearable. They usually occur on one side of the face, but in rare cases, they may be two-sided. Painful attacks may occur spontaneously but are more often associated with a specific stimulus in a "trigger area." Common trigger points are the eyebrow, the upper lip, and the lower molar teeth. Sensory stimuli by touch, cold, wind, talking or chewing can trigger the attacks. Pain-free intervals last for minutes to weeks, but long-term spontaneous remission is rare. The attacks stop during sleep but often occur when awoken in the morning.

THE CURE: The primary treatment of trigeminal neuralgia is pharmacological. However, if pharmacologic management is ineffective, surgical intervention is required. The first-choice treatment is microvascular decompression surgery (MVD). It involves surgically opening the skull and exposing the nerve at the base of the brainstem to insert a tiny sponge between the compressing vessel and the nerve. This sponge isolates the nerve from the pulsating effect and pressure of the blood vessel. By removing the compression, the painful symptoms are relieved.
(SOURCE: www.mayfieldclinic.com)

Joanne H. Nicholas
Director, Public Affairs
Continuum Health Partners
(212) 523-7772

(Information provided by Ivanhoe)

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