Dr. James Bowen, Medical Director at the MS Center of the Swedish Neuroscience Institute answered questions about Trigeminal Neuralgia (TN) at The Alaska Multiple Sclerosis Center (AMSC) dinner. He said the first line is pharmaceuticals.
If the medications don’t take care of the pain, surgery is another option.
With MS, damage has to be done to the pain fibers of that nerve.
Dr. Bowen spoke of two ways and the University of California, San Francisco (UCSF) documented detailed information about TN surgery
1. Radiofrequency Lesion (RFL)
Radiofrequency lesion is a good option for severe pain in high-risk patients, such as patients with concurrent illness that would make an open surgical procedure too dangerous. It is also a good option for patients with multiples sclerosis (MS), whose TN is often not caused by vascular compression. Like Gamma Knife treatment, radiofrequency rhizotomy does not treat the root cause of TN, but instead damages the trigeminal nerve, to stop the transmission of pain signals. In RFL, an electrode inserted through the cheek is used to heat the nerve and cause selective damage to stop pain signals from traveling to the brain. The treatment provides immediate pain relief in up to 90% of patients, but can cause more facial numbness than the other procedures and has a pain recurrence rate of 40% at 2 to 3 years post-surgery. If necessary, the procedure can be repeated.
What are the potential side effects of radiofrequency rhizotomy?
While radiofrequency rhizotomy is less invasive, less risky, and requires less time in the hospital than MVD, this technique also has a higher rate of pain recurrence. Radiofrequency rhizotomy also carries a greater risk of minor to severe post-surgical numbness, which can often be permanent. This procedure also carries the rare general surgical risks of infection and excessive bleeding, as well as excessive nerve injury, corneal numbness, anesthesia dolorosa, and intracranial hemorrhage.
Will I have pain when I wake up?
Patients may have some cheek pain at the needle insertion site. This usually resolves within one week.
How long will I need to stay in the hospital?
Radiofrequency rhizotomy for TN is an outpatient procedure–you will be able to go home the same day of your treatment.
When may I resume normal activities?
Patients usually begin to return to normal activities within 48 hours, though this depends on the individual.
Will surgery be completely curative?
No one can promise that any surgery for TN will be successful for all patients; Radiofrequency rhizotomy “scrambles” the pain pathways, but there is always a chance that the pain can recur at a later date.
UCSF is currently involved in a continuing long-term study of the efficacy of Gamma Knife radiosurgery.
Radiosurgical (Gamma Knife