Sunday, November 14, 2010

Microvascular Decompression Trigeminal Neuralgia

Microvascular Decompression surgery is a medical procedure that is often done to provide pain relief that is associated with the trigeminal neuralgia. Trigeminal Neuralgia is caused when the fifth cranial nerve is irritated. This will result in the individual experience severe pain, usually on one side of the face.

Generally when Microvascular Decompression is used to treat trigeminal neuralgia, the skull is opened where the trigeminal nerve is located. Doctors will place a small sponge between the nerver and either the petrosal vein or cerebellar artery. This sponge will remove any compression the vessels may cause on the nerve.

Be Wary of Facial Pain, It Could Be Trigeminal Neuralgia

People who often experience bouts of pain in the nose, lips, jaws, eyes, or forehead should be very wary. All these symptoms could be signs of the very serious medical condition known as Trigeminal Neuralgia (TN).

Trigeminal Neuralgia is a very common condition, were the patient suffers from excruciating pain. This condition has been often called the “suicide disease”, as many people cannot handle the intense pain and would rather end their life and instead of dealing with it.

This condition usually occurs when an arm of vein or artery makes contact with a nerve at the bottom of the brain. The contact caused by the vein or artery will cause pressure to be placed on the nerve and this in turn results in a breakdown or something going wrong in the brain.

The episodes of pain associated with the condition can be extremely severe. It can be triggered by different activities such as brushing the teeth, chewing and even wind blowing on the face. Generally only one side of the face is affected by pain at a given time. The pain can be focused in one area or spread into a much wider area.

There are many different treatments for this particular condition. These include the use of different types of medications, drugs and injections. If any of pulse fail to work, then surgery / Gamma Knife  is often considered.

Trigeminal Neuralgia: What You Need To Know

Trigeminal Neuralgia (tic douloureux) is a painful neurological condition that many people often claim is a curse, due to the pain associated with it. It is a rare condition and it is mostly found in people over 50 years of age, even though people in other age groups can be affected by it. Women have a higher chance of getting the condition and this is 1.5 more times likely, compared to men. The Trigeminal Neuralgia Association has stated that 5% of patients who suffer from this condition also have a family history of it.

The pain associated with Trigeminal Neuralgia can be debilitating as the pain is so severe. The symptoms associated with the disorder are severe facial pain, which affects one side of the face. The pain is a result of an artery or blood vessel pressing down on the trigeminal nerve located at the base of the brain. Generally the pain from the condition, usually affects the lower parts of the face such as the jaw. The pain is often described as a sharp, acute pain that is almost similar to electric shocks.

Aside from the blood vessels pressing down on the Trigeminal Neuralgia, damage to the nerve can also because by injuries to the face, surgical or dental procedures. However in many of the patients who suffer from this condition, there is no outright cause.

The onset of pain associated with Trigeminal Neuralgia can often be triggered by simple actions such as eating, brushing the teeth, applying makeup, shaving, sneezing, drinking cold or hot beverages and even a light wind. Most people who suffer from the condition often state that the pain just appeared out of nowhere one day.

Dr.Sanjay Mongia

Friday, November 12, 2010

Radiosurgery Effective for MS-Trigeminal Neuralgia

Gamma knife stereotactic radiosurgery (GKS) appears to be an effective option for the long-term management of trigeminal neuralgia (TN) associated with multiple sclerosis (MS), according to a study  presented at the annual meeting of the American Society for Radiation Oncology, held from Oct. 31 to Nov. 4 in San Diego.

Tejan P. Diwanji, of the University of Maryland in Baltimore, and colleagues treated 13 MS patients with TN with GKS between 1998 and 2001 and followed them for a median of 67 months after treatment.
The investigators found that the median time to pain relief was one week. Six patients discontinued their TN-related medications. However, none of the patients who had no TN symptom relief after GKS were able to reduce or discontinue TN-related medications. The median duration of pain relief for patients that responded to the first GKS was 36 months. Actuarial freedom from treatment failure was 42.9 percent at one and three years and 28.6 percent at five years. No treatment-related complications were observed. Only one patient experienced transient numbness after GKS .

Tuesday, October 26, 2010

Sunday, February 21, 2010

Friday, February 19, 2010

Diagnosis of Trigeminal Neuralgia

In addition to a thorough history and physical examination, magnetic resonance imaging (MRI) of the brain is recommended. This procedure helps identify a brain tumor in the rare cases in which it is present along with Trigeminal Neuralgia . It may also help to diagnose multiple sclerosis. Often when the MRI is performed, some contrast material is injected into the vein so that the appearance of a small tumor, blood vessel, or other structures in the brain can be enhanced and made easier to detect.

Trigeminal Neuralgia

Gamma Knife for Trigeminal Neuralgia

Gamma Knife Radiosurgery is a method for treating certain problems in the brain without making an incision. Two hundred-one beams of cobalt-60 radiation are focused precisely on a specific region in the brain. In the case of TN, the target area is the trigeminal nerve, just where it leaves the brain. The treatment does not require general anesthesia, and the patient stays in the hospital for less than five hours.

Any patient with trigeminal neuralgia who has pain or has difficulty with the medicines used to relieve the pain is an excellent candidate for GKRS. The patient's age or medical condition does not affect the decision to have GKRS. Even the elderly or medically infirm can undergo this treatment. Patients who are receiving anticoagulants for other medical conditions do not have to stop or reverse the anticoagulation therapy prior to GKRS. Those who have had previous procedures for TN may also undergo GKRS. Patients who are concerned about the possibility of numbness are particularly good candidates for GKRS, because the chance of postoperative numbness occurring is very small. Patients who poorly tolerate medicines given for sedation and relief of pain during a procedure are also very suitable for GKRS because these medications are not necessary.

Gamma Knife for Trigeminal Neuralgia

Symptoms of Trigeminal Neuralgia

The disorder is characterised by episodes of intense facial pain that usually last from a few seconds to several minutes or hours. The episodes of intense pain may occur paroxysmally. To describe the pain sensation, patients may describe a trigger area on the face, so sensitive that touching or even air currents can trigger an episode. It affects lifestyle as it can be triggered by common activities such as eating, talking, shaving and toothbrushing. The attacks are said by those affected to feel like stabbing electric shocks, burning, pressing, crushing, exploding or shooting pain that becomes intractable.

Individual attacks usually affect one side of the face at a time, lasting from several seconds to a few minutes and repeat up to hundreds of times throughout the day. The pain also tends to occur in cycles with remissions lasting months or even years. 10-12% of cases are bilateral, or occurring on both sides. This normally indicates problems with both trigeminal nerves since one serves strictly the left side of the face and the other serves the right side. Pain attacks typically worsen in frequency or severity over time. Many patients develop the pain in one branch, then over years the pain will travel through the other nerve branches.

Outwardly visible signs of TN can sometimes be seen in males who may deliberately miss an area of their face when shaving, in order to avoid triggering an episode. Successive recurrences are incapacitating and the dread of provoking an attack may make sufferers unable to engage in normal daily activities.

Thursday, February 11, 2010

Trigeminal Neuralgia Causes

Several theories exist to explain the possible causes of this pain  syndrome. It was once believed that the nerve was compressed in the opening from the inside to the outside of the skull; but newer leading research indicates that it is an enlarged blood vessel - possibly the superior cerebellar artery - compressing or throbbing against the microvasculature of the trigeminal nerve near its connection with the pons. Such a compression can injure the nerve's protective myelin sheath and cause erratic and hyperactive functioning of the nerve. This can lead to pain attacks at the slightest stimulation of any area served by the nerve as well as hinder the nerve's ability to shut off the pain signals after the stimulation ends. This type of injury may rarely be caused by an aneurysm  (an outpouching of a blood vessel ); by a tumor ; by an arachnoid cyst  in the cerebellopontine angle ; or by a traumatic event such as a car accident or even a tounge piercing.
A large amount of multiple sclerosis patients have TN, but not everyone with TN has MS. Only two to four percent of patients with TN, usually younger, have evidence of multiple sclerosis , which may damage either the trigeminal nerve or other related parts of the brain. It has been theorized that this is due to damage to the spinal trigeminal complex  . Trigeminal pain has a similar presentation in patients with and without MS.
 Post herpetic Neuralgia , which occurs after shingles , may cause similar symptoms if the trigeminal nerve is damaged.
When there is no structural cause, the syndrome is called  Idiopathic . 

Trigeminal Neuralgia

Trigeminal neuralgia (TN), tic douloureux (also known as prosopalgia) is a neuropathic disorder of one or both of the trigeminal nerves . Its nickname is "the suicide disease" because of severe associated pain , and the fact that it is not easily controlled or cured. It causes episodes of intense pain in any or all of the following: the ear, eye, lips, nose, scalp, forehead, teeth or jaw on one side and alongside of the face. It is estimated that 1 in 15,000 people suffer from trigeminal neuralgia, although the actual figure may be significantly higher due to frequent misdiagnosis. 

TN usually develops after the age of 50, more commonly in females, although there have been cases with patients being as young as three years of age .

TN brings about stabbing, mind-numbing, electric shock-like pain from just a finger's glance of the cheek or spontaneously without any stimulation by the patient. Cold wind, high pitched sounds, loud noise such as concerts or crowds, chewing, talking, can aggravate the condition, and for the worst cases, even smiling, a scarf, the wind or hair on the side of the face is too much to bear.

Trigeminal Neuralgia