Carmen’s story

 Trigeminal neuralgia, microvascular decompression surgery

Decompression surgery resolves symptoms of trigeminal neuralgia

Carmen's facial pain started with a routine dental cleaning.

After leaving the dentist's office, she felt a tingling on the left side of her face, from her temple down through her jaw. The pain flared when she brushed her hair, brushed her teeth or touched her face. Before long, she was experiencing periodic stabbing or "electric pain."

Seeking answers, Carmen consulted with a brain specialist and got her diagnosis: She was suffering from trigeminal neuralgia, a neurologic disorder marked by episodes of debilitating facial pain. It originates from the trigeminal nerve, a sensory nerve that runs from the face to the brainstem and supplies feeling to a patient's face.

The pain quickly became a serious problem for Carmen, waking her up in the middle of the night and causing several trips to the emergency room. Medication, usually the first step in treatment, provided some relief. But Carmen struggled with side effects, and the episodic pain meant she sometimes had difficulty even talking.

"It was so intense, I was not able to work," she says. "I told my doctor, 'We need to figure this out. I cannot live this way.'"

She was referred to Mayfield Brain & Spine, where she met with neurosurgeon Dr. Yair Gozal. He presented her with several options: Continued medication; microvascular decompression surgery to reduce pressure on the trigeminal nerve by moving adjacent blood vessels that are causing irritation; Gamma Knife radiosurgery, which focuses radiation to damage that portion of the trigeminal nerve; and percutaneous stereotactic rhizotomy (PSR), which uses heat energy to destroy some of the nerve fibers carrying pain signals to the brain.

Dr. Gozal said the effectiveness of the different treatment options can depend on the type of pain and whether the trigeminal nerve is being compressed. With Carmen, he said, the fact that medications did not completely relieve her symptoms, plus scans showing pressure on the trigeminal nerve from adjacent blood vessels, made decompression surgery the recommended option.

"Carmen came to us in clear distress, and the level of pain was affecting her daily life, indicating a significant impact on the trigeminal nerve," Dr. Gozal said. "After a discussion of the benefits and risks of each approach, she chose to proceed with surgery."

During MVD, a sponge is inserted between the trigeminal nerve and the blood vessel to relieve the compression that causes the painful neuralgia attacks.

In the operating room, Dr. Gozal gained access to the trigeminal nerve through an incision behind the ear, called a retrosigmoid craniotomy. The surgical team saw clearly that a branch of a large brain artery was impinging on the trigeminal nerve. Dr. Gozal relieved compression on the nerve and placed a small Teflon sponge to protect it.

After the surgery, Carmen experienced some residual pain and numbness for several weeks. Eventually, she was able to wean herself off trigeminal pain medications. While she still feels some tingling occasionally, the pain in her face and mouth is gone.

Dr. Gozal said the case shows the importance of carefully considering treatment options, both surgical and non-surgical, before proceeding.

"Every patient is different, and Carmen chose the best treatment option to relieve her symptoms," he said. "She has responded well to the surgery and is getting back to her normal life. She also has become an advocate to help educate others about trigeminal neuralgia."

Today, Carmen is basking in being free of the pain that had slowed her life to a crawl.

"Dr. Gozal explained all of the options to me, and I thought that surgery was the best way to relieve the pain," she said. "I was feeling miserable, but now I'm feeling great. It's as normal as it can be."

~ Cliff Peale

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Yair Gozal, MD, PhD

Related links:

Trigeminal neuralgia

Microvascular decompression