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What is Trigeminal Neuralgia Radiosurgery?

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  • Written By: Greg Caramenico
  • Edited By: Daniel Lindley
  • Last Modified Date: 04 December 2016
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Trigeminal neuralgia radiosurgery, also called stereotactic radiotherapy, is a method of treating severe facial nerve pain. Unlike other kinds of surgical intervention, it does not require an incision, and is instead performed using focused radiation applied to a specific part of the trigeminal nerve. In cases where open procedures cannot be performed or are not recommended, radiosurgery is an effective alternative. Gamma knife is a common type of trigeminal neuralgia radiosurgery with established results in relieving pain.

Trigeminal neuralgia is a chronic condition of the trigeminal nerve that carries facial sensations to the brain. Patients, typically elderly and often female, experience facial pain that worsens in intensity and duration over time. Like the other cranial nerves, trigeminal fibers run through to the brain stem, so pain can occur at many different spots. Some neuralgia is caused by a blood vessel pressuring the trigeminal nerve, and can be treated by microvascular decompression surgery. Many cases of trigeminal pain have unclear causes, and neurosurgery frequently blocks the nerve's function so that it no longer carries pain signals, regardless of the underlying disease or malfunction.

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When pain medication cannot relieve facial neuralgia, surgery often is the best option. Many neurosurgical techniques involve manually cutting the nerve to relieve the pain. Trigeminal neuralgia radiosurgery, by contrast, uses beams of radiation to operate without actually opening up the skull or the face. Radiosurgery is especially useful for patients who have medical conditions that make incisions too risky to perform as a treatment of facial nerve pain. Sometimes surgeons use a linear-accelerator that strikes the targeted fibers with high-energy X-rays to kill fibers in the trigeminal tract.

Many surgeons performing trigeminal neuralgia radiosurgery use the gamma knife procedure. It does not require an incision, but instead focuses cobalt-60 radiation on the trigeminal nerve just above the point where it exits the brain and proceeds toward the face. This causes selective ionization of neurons, leading to cell death. The goal is to destroy the nerve fibers that carry the sensation of pain before they join the pathway back to the brain stem. The procedure has relatively few complications, and relieves trigeminal pain of many different origins.

Some clinical studies indicate that as a primary treatment, microvascular decompression is more effective at relieving the causes of neuralgia than stereotactic radiotherapy. Despite this, for those seeking immediate relief, and for patients who have required repeat surgeries to stay pain-free, neurosurgeons sometimes prefer trigeminal neuralgia radiotherapy. Microvascular decompression is riskier and more involved, so there are also cases where gamma knife surgery can be the recommended first choice due to its minimal invasiveness. Compared to many other surgical and medical treatments, trigeminal neuralgia radiosurgery is quite effective at reducing chronic facial pain.

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