Jeffrey A. Brown, M.D.
Neurological Surgery, P.C.
600 Northern Blvd., Suite 118
Great Neck, NY 11021
516-478-0008
http://www.neurosurgeryli.com/dr.brown.html
Transcript: MS – A difficult problem
Multiple Sclerosis - a very difficult problem. I think it’s well accepted that the results in the treatment of trigeminal neuralgia in patients with multiple sclerosis are only about half as good as they are for the rest of the population which means those patients are twice as likely to need another operation after their first operation and most commonly that first operation is some kind of additional injury to the trigeminal nerve.
Yes, there are talks about giving a microvascular decompression but maybe it would be best suited for those patients who are doubly darned if they have multiple sclerosis and they have a vascular association, it’s possible but it’s hard to sort out. That patient could get better with a microvascular decompression but if it is classical multiple sclerosis without that, then there isn’t an ideal choice.
Some people recommend glycerol, some people recommend gamma knife. I tend to perform the balloon compression because I’ve done that for two decades and I know that my goal is to do the least damage possible and with the balloon compression, I can control how much damage that I create.
I do that by measuring the pressure and the duration of time I squeeze the nerve. So I have a very good idea that I’m not going to do too much. Because too much in a multiple sclerosis patient is much too much because it leads in the end to the onset of that odd pain, that burning pain, that constant pain that you can’t do anything easily about and as long as we know that we’re going to have to repeat this operation many times over the course of a lifetime, I want to do the least possible.
I would do the balloon compression because I feel very comfortable with it. Maybe others feel more comfortable with other procedures such as glycerol but with glycerol, I can’t measure what I’m doing as well as I can simply by looking at the pressure I am squeezing that nerve and the number of seconds that I’m squeezing it so that’s what I feel comfortable recommending.