Radiosurgery uses radiation beams targeted with high precision to injure the root of the nerve, thereby stopping pain signals. It is often referred to as ‘Gamma Knife’ surgery but no knife is involved.
Advantages
This treatment is non-invasive, virtually pain-free and can be done on most individuals. Does not require a general anaesthetic and so no need for hospital admission.
Disadvantages
Permanent numbness in the face can occur, even as long as six months later, and the long-term effects of radiation are uncertain.
Motor-Cortex Stimulation
In this major new surgery, electrodes are placed on the surface of the brain over the area that controls movement to the face. Stimulating this region reduces activity in the area where pain is felt.
This is a possible option for those with nerve pain that may not be helped by other procedures. Most patients with unrelenting pain experience at least 50% improvement and it is believed that success rates for this operation will increase over time.
This is considered an experimental procedure. Seizures can occur if levels are set too high. Strokes are rare but possible.
Your Questions Answered
Which surgeon should I use?
Do not be afraid to question the neurosurgeon! You can request a brain scan to rule out other conditions and perhaps see the cause of the pain. The more experienced the neurosurgeon, the fewer the complications; for MVDs, the surgeon needs to be doing 4-5 procedures a year. But it is important to note that a recurrence of TN is possible after surgery.
I don’t have ‘typical’ TN – will surgery work for me?
This depends on a range of factors (see ‘Quick Facts’). In ‘atypical’ cases the full range of procedures is available, but results are not as good. For those with Multiple Sclerosis (MS), through-the-cheek methods are preferred. With Post Herpetic Neuralgia (PHN), medicines, rather than surgery, are most commonly used. Nerve injury pain is also mainly treated with medicines, TENS units or motor-cortex stimulation could be used.
Will surgery stop my pain?
Whilst the aim of all procedures is to stop or minimise TN symptoms, the recurrence and success rates differ depending on which procedure is used. MVDs may fail for a variety of technical reasons and in some cases, nerve compression may just not be the cause. With radiofrequency lesioning, the surgeon may apply less heat to disrupt the pain transmission, while minimising loss of sensation (numbness). With glycerol injections, the glycerol may drain out of the area where it’s needed, before it has a chance to work. In radiosurgery, even slightly inaccurate targeting can miss the nerve and therefore deliver too little radiation to damage the nerve. Pain relief can also often be delayed.
How can I find out more?
You may find it useful to talk to other patients who have had surgery. We can put you in touch with others who have undergone various procedures and TNA UK members can contact us for further details about surgeons, specific surgeries or any of the issues covered above.
