Blood Vessels – A common cause of pain

Trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia are most often caused by a blood vessel that is pressing itself into the side of a cranial nerve.  In the case of trigeminal neuralgia, the most common offending vessel is called the superior cerebellar artery (SCA).  Although this artery is technically “normal”, it can push on the trigeminal nerve and cause facial pain.

In the case of hemifacial spasm, the most common offending blood vessel is the anterior inferior cerebellar artery (AICA).  In this case, AICA touches the facial nerve, resulting in spasms of the face and eye that occur sporadically throughout the day.

In the case of glossopharyngeal neuralgia, the most common offending blood vessel is the posterior inferior cerebellar artery (PICA) which can press on the glossopharyngeal nerve resulting in severe pain that involves the side of the neck or throat.

Minimally Invasive Treatment Options – There’s hope for pain relief

Microvascular decompression surgery or MVD is a surgical procedure designed to create a buffer between the cranial nerve that’s “in trouble” and the blood vessel that is pushing on the nerve. MVD surgery is a surgical treatment performed under general anesthesia in a hospital operating room. Patients are fully asleep during this surgical procedure. During an MVD, space between the blood vessel and nerve is created by placing a few small teflon sponges between the cranial nerve and the blood vessel. For trigeminal neuralgia, sponges are placed in between the SCA and the trigeminal nerve using an operative microscope.

MVD surgery is always performed by an experienced neurosurgical team. This team of experts includes a brain surgeon, a neuro-anesthesiologist, neurosurgical surgical “scrub” technicians, operating room nurses and an experienced neurophysiologist. Throughout the surgical procedure, patients are kept safe by using special monitoring equipment designed to ensure that functions of the brain and brainstem are protected throughout the surgical procedure. Critical cranial nerves for facial movement, hearing, and swallowing are in play, so an experienced neurosurgical team is critical to preventing hearing loss, facial numbness, or other potential side effects. With an expert team, MVD surgery can be extremely safe and beneficial to patients. Long term, most successful MVD patients remain pain free and off medications.

Gamma Knife Radiosurgery (GKRS)

Gamma Knife Radiosurgery (GKRS) is not traditional surgery.  Rather, Gamma Knife Radiosurgery is a minimally invasive way of treating painful nerve disorders like trigeminal neuralgia without a knife.  Using highly focused, pin-point radiation, GKRS is an effective way to treat facial pain that has not responded to medications.

GKRS places a focused dose of radiation on the cranial nerve that is causing pain.  In the case of trigeminal neuralgia, a small “shot” of radiation is placed on the trigeminal nerve where the blood vessel is touching the nerve.  In many cases, this location is on the trigeminal nerve just before the nerve plugs into the brainstem.  GKRS is painless and general anesthesia is not required.  Patients leave the Gamma Knife facility on the same day of treatment, often before lunch, and have very few restrictions after the procedure is complete.

Long-term, approximately 70-80% of patients experience durable pain relief.  Many patients can be pain-free and off medications anywhere from 6-12 weeks after GKRS.  Potential complications of GKRS include facial numbness.  This can occur in anywhere from 5-10% of patients.  Gamma Knife Radiosurgery can be repeated in the future should the facial pain come back long-term.