UK
TRIGEMINAL NEURALGIA ASSOCIATION
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Elisabeth BOULOT�������������������������������������������������������������������������������������������������������������
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TNAssociation (USA) web-site: http://www.tna-support.org
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CONSIDERING SURGERY FOR TN
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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.
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Microvascular
Decompression (MVD)
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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.
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Peripheral procedures
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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)
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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.
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Gamma Knife
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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
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Comparing the different procedures
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MVD
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Disadvantages:
major surgery,
and therefore complications may occur, including hearing loss, dizziness or
death (less than 1%).
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Advantages:
Numbness is very
unusual. The effect of the surgery is longer : after 5 year, 75% of the
patients are still free of pain.
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Peripheral procedures
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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.
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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.
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Conclusion
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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.
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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 ?
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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.
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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.