Elsie's story

    Trigeminal neuralgia

Gamma Knife radiosurgery relieves facial pain from trigeminal neuralgia

Every fall, Elsie knew the pain on one side of her face was coming. It appeared when she took a shower, or when she was outside in a breeze. The sudden and intense pain – she likened it to the sensation after accidentally touching an electrical wire – came more often as the years passed.

"It got to the point where I couldn't stand to touch my face, and I couldn't let water hit my face at all without feeling the pain," Elsie says now. "If I was outside and the wind would hit my face, I knew the pain was coming."

For more than 20 years, Elsie had suffered from trigeminal neuralgia – episodes of debilitating pain in the face that often occur without warning and may be triggered by touching specific areas of the face. It originates from a short-circuit within the trigeminal nerve, a sensory nerve that runs from the face to the brainstem and supplies feeling to a patient's face.

"If I was outside and the wind would hit my face, I knew the pain was coming" Elsie says.

By 2019, Elsie's pain was coming every year, starting when the weather started to turn colder and extending to the following spring. She consulted a variety of doctors, including a neurologist. Medications did not resolve the problem, and Elsie resigned herself to the fact that it wasn't going away without surgery. She started searching for a neurosurgeon who could help.

That search led her to Mayfield Brain & Spine and Dr. Ronald Warnick, one of the nation's foremost specialists in stereotactic radiosurgery, who has performed more than 4,200 radiosurgery procedures in his career. In August 2021, Elsie underwent the procedure at the Gamma Knife Center at The Jewish Hospital – Mercy Health. Before long, her pain was gone.

Gamma Knife radiosurgery uses 192 beams of radiation to target damaged cells in the brain. It often is used as a less-invasive alternative to treatment of brain tumors and other disorders of the brain. With trigeminal neuralgia patients, the procedure uses targeted radiation beams to relieve pain by promoting inflammation in the trigeminal nerve fibers. Dr. Warnick says Gamma Knife radiosurgery is a viable option for those suffering from the painful symptoms of trigeminal neuralgia.

"Elsie has dealt with the regular bouts of facial pain for years, and when medication failed to provide relief, we reviewed options including radiosurgery," said Dr. Warnick, co-director of the Gamma Knife Center. "About half of radiosurgery patients with trigeminal neuralgia experience pain relief within one month after the procedure, and 90% are pain-free after three months. We are gratified that Elsie is among those who have realized the benefit of this minimally invasive procedure."

Gamma Knife radiosurgery is an outpatient procedure where no incisions are made. There is minimal impact on surrounding tissue and a frame around the head is used to ensure the radiation meets its target. Elsie says she felt comfortable throughout the procedure. And after the radiosurgery, as fall and winter came last year, she remained free of the facial pain.

Clinicians at the Center operate as a multi-disciplinary team – including neurosurgeons, radiation oncologists, medical physicists and critical care nurses who create the patient's treatment plan and perform the procedure.

Dr. Warnick and his colleagues with the International Radiosurgery Research Foundation have advanced research on the effectiveness of stereotactic radiosurgery to treat trigeminal neuralgia. The consortium's studies demonstrate that trigeminal neuralgia patients treated with stereotactic radiosurgery within four years of diagnosis have better pain relief with lower risk. Dr. Warnick is also the principal investigator of an international study on trigeminal neuralgia to determine the relationship between biologically effective radiation dose and clinical outcomes.

"Radiosurgery is a complex, multistep procedure that requires a high level of dedication to quality and safety," Dr. Warnick says. "At the Gamma Knife Center, we have used rigorous self-analysis to ensure the safety and reliability of the care we provide, even as we constantly innovate to create better solutions for our patients."

Today, Elsie is free of any pain in her face. And just as important, she has lost much of the anxiety she once experienced every fall that the pain would suddenly reappear.

"I'm so glad I had the surgery and got that over with," she says. "Dr. Warnick was great. He just explained everything so well. And the staff at Jewish Hospital was so professional. I just really appreciate everything they did for me."

>> more hope stories