Bob's story

Trigeminal neuralgia

The treatment would have a double meaning. For Bob, it would mark the end of the excruciating pain of trigeminal neuralgia, an inflammation of the facial nerve. For Bob's neurosurgeon, Dr. Ronald Warnick of Mayfield Brain & Spine, it would mark his 3,000th stereotactic radiosurgery procedure.

Although Bob didn't realize that his life-changing treatment would intersect with another man's milestone, he was keenly aware that he had one of the most experienced specialists in radiosurgery. Dr. Warnick has played a role in the evolution of the field for 25 years. Equally important to Bob, he had a doctor who felt his pain.

"Dr. Warnick is a genuine person, a real caring person," Bob says. "I went in to see him, and the first thing he said to me was, 'I'm sorry that you've got this.' I appreciated that. It was the first time anyone had said that to me." Bob was in his early 60s when he began to experience knife-like pain on the right side of his face. "It feels like someone frayed an electrical cord and stuck it in your face," he says. "There's nothing you can do to ease the pain."

It arrived "with a vengeance," lingered a few days, then went away, only to reappear a few months later. Bob had no idea what was causing it. He had never heard of trigeminal neuralgia. He figured something was amiss with his sinuses.

In fact, because Bob had multiple sclerosis, he had a 20 times higher likelihood of developing trigeminal neuralgia than the general population. About 2 percent of people who have MS will develop the condition at some point in their lives.

Bob's last onset of facial pain differed from the others. It began in January of 2017 and never went away. It came in waves, four or five times a day. When a wave of agony struck, Bob gritted his teeth. If he was talking on the phone at work, he stopped. He missed a few days of work, then an entire week.

As the months went by, Bob learned about Gamma Knife®, a non-invasive, outpatient treatment for trigeminal neuralgia. He discussed it with his primary care doctor, who recommended the Gamma Knife Center at The Jewish Hospital – Mercy Health. Gamma Knife radiosurgery appealed to Bob because it did not involve a real knife and would take less than a day. "I would miss less work," he says. "I don't know why I worried about that, but I did. That made my decision."

On August 1, Bob had an MRI and then saw Dr. Warnick in office. Nine days later, he arrived at the Gamma Knife Center at 7 a.m. At the time neither Bob nor Dr. Warnick realized that it was Dr. Warnick's 3,000th radiosurgery case. Dr. Warnick would determine that retroactively a few months later.

"Whether my 300th or my 3,000th, every single patient is unique, not just a disease or group of symptoms," Dr. Warnick says. "I strive to understand their particular challenge and focus all of my time and expertise on their well-being."

Dr. Warnick immobilized Bob's head in a rigid head frame, securing it with four small pins after numbing the areas. A coordinate box was attached to the frame, and Bob then underwent a series of brain scans. The coordinate box would provide reference points on the images that would be used for accurate targeting during his treatment planning and delivery. Bob then rested quietly while Dr. Warnick and his team planned the radiosurgery treatment.

Later that morning, fully awake, Bob underwent radiosurgery. With the head frame holding his head perfectly still, the Gamma Knife delivered 192 beams of radiation to the root of the trigeminal nerve over a period of about 60 minutes. Dr. Warnick then removed the frame, placing a small stitch at each pin site.

"I was done by about 11:30 a.m. and in no pain from any of the procedures," Bob recalls. "The worst thing was that because of the screws, you can't lie on the back of your head the first night. My wife solved that problem by rolling up a towel and placing it under my neck. My trigeminal pain quit that afternoon."

Three months later, Bob says he is "95 percent pain free." His voice, which he had lost because of the trigeminal neuralgia, was coming back. In his mid-60s, he was ready to enjoy a nice retirement, but his office had other ideas. Instead of losing him, they allowed him to work full-time from home.

Reflecting on his experience, Bob is quick to thank all who took care of him. "Everyone with Mayfield and the hospital was as nice as they could be," he says. "They did their job and helped me be at ease. I flew through it without any difficulty at all."

Meanwhile, Dr. Warnick will never forget Bob, a milestone patient and – more importantly – a patient successfully treated.

~ Cindy Starr