Mark E. Linskey, M.D.
Department of Neurological Surgery
University of California, Irvine Medical Center
101 The City Drive, Bldg. 56, Suite 400
Orange, CA 92868
714-456-6966
http://neurosurgery.uci.edu/facultybio/linskey/
Transcript: Questions to ask a neurosurgeon about trigeminal neuralgia
Patients always wonder what sort of questions they should ask a surgeon when they go for a consultation about trigeminal neuralgia. And in my opinion, it breaks down to several things.
First of all, who trained them to do the procedure? Did they pick it up themselves or were they trained by a recognized expert in that procedure? That’s particularly important for microvascular decompression.
Second. How many have they done? Microvascular decompressions or even some of the other procedures are not things that you can do occasionally. There’s a learning curve that you want your surgeon to be over before they start to treat you. The number that is needed to get over this will vary surgeon to surgeon and procedure to procedure. For microvascular decompression, that number is estimated to be somewhere between 50 and 100 procedures.
The next question that I think is important is what is their regular recurring volume? How many of these are they doing per year so that they keep their skills up and their complication rates low? We have good data now that that makes a difference. And the general rule of thumb that I use is at least one procedure a month is a good ballpark figure.
Other questions are procedure specific and I’ll give you two examples. For microvascular decompression, it is extremely important that the surgeon be using auditory brainstem evoke response monitoring during the procedure. We have multiple studies that show that that type of intraoperative monitoring will lower the risk of hearing loss by at least 50% and that’s an important factor. The second relates to Radiosurgery. We have plenty of data now that almost all Radiosurgery techniques will give you similar pain control rates but that’s not true for complications. The type of technology that gives you the lowest risk of numbness remains Gamma Knife and that remains the gold standard for treatment. So things such as CyberKnife®, Novalis, Varian Trilogy or alternatives along these lines are not Gamma Knifes. They’re other forms of Radiosurgery and their use for trigeminal neuralgia in my personal opinion is one that still requires more investigation and more perfection of technique before it will be equivalent.