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Trigeminal Neuralgia Clinical Information

Trigeminal neuralgia is a disorder in which sudden lightning-like pains strike the face. In its severe form it is regarded as the most excruciating pain that a person can experience. Drug therapy (especially carbamazepine and baclofen) is often effective in relieving the pain, but when medications fail surgical treatment will provide relief in almost all cases. Over 3000 patients with trigeminal neuralgia have had surgery at the University of Florida using either the stereotactic radiofrequency procedure or a microvascular decompression operation. The stereotactic radiofrequency procedure is an outpatient procedure.
Drawing: Illustrates  3 branches of the trigeminal nerve

After the induction of Brevital anesthesia, a lesioning needle is inserted under fluroscopic guidance, through the foramen ovale, into the trigeminal ganglion. After checking and adjusting the needle position with electrical stimulation, a radiofrequency heat lesion is made. The main advantage of the radiofrequency procedure is that it can be done as an outpatient with the patient returning home a few hours after the operation. The main disadvantage is that it causes permanent numbness of a portion of the face.

Microvascular decompression (the Janetta procedure) does not result in the numbness associated with a radiofrequency procedure. The vascular decompression operation is a major surgical procedure, which commonly requires 2 to 3 days in the hospital after surgery. After the induction of general anesthesia, the patient is positioned, prepped, and draped for a retromastoid craniotomy. A small (half dollar sized) opening in the skull, allows the superior lateral corner of the cerebellum to be retracted. The trigeminal nerve is easily visualized with the operating microscope. During the operation, a vessel (often the superior cerebellar artery) is usually found compressing the root entry zone of the trigeminal nerve. This vessel is dissected free and padded to prevent recurrent compression. This results in permanent relief of pain, without facial numbness, in the vast majority of cases.

Similar microvascular decompressive surgery has also proven quite successful in the treatment of hemifacial spasm. In this disorder, the seventh nerve is frequently compressed by branches of either the anterior inferior cerebellar artery or the posterior inferior cerebellar artery.

Please contact Dr. Friedman for more information.

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