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: Should I consider a minimally invasive trigeminal neuralgia surgery approach first?
It is common for patients with trigeminal neuralgia when they’re beginning to consider surgery to hear that perhaps they should consider a minimally invasive procedure first. The rationale goes that if it doesn’t work, you can always do something more, you haven’t lost anything but that you’ve potentially avoided the complications of the more invasive procedure if it was successful. But there are several significant problems with this rationale and approach that patients often don’t understand.
The first is that time is a very important factor for the chances of long term result with a more definitive procedure like microvascular decompression. The cut-off statistically in one study was at eight years and in a more recent study, it was down at three years. It’s going to obviously depend on the individual patient. What matters is not the number of years. What matters is that if you’re delaying getting to the more definitive procedure you may have a worse result.
The second problem is that the minimally invasive procedure that’s talked about most is Gamma Knife Stereotactic Radiosurgery. And just like Radiofrequency or glycerol rhizotomy or balloon compression, this is a palliative destructive procedure. You’re damaging the nerve on purpose in a controlled manner. You’re not taking away the cause. You’re trying to treat the symptom at a risk of causing numbness but you create a lesion on purpose in the nerve and that can become an independent cause for facial pain. Independent of the vascular compression down the road. Much like a stroke in the nerve or a MS plaque in the nerve, those are other lesions within the nerve. So having a destructive procedure prior to a microvascular decompression also reduces the chances of successful long-term outcome.
And finally, your risks of the more invasive procedure, the microvascular decompression, are usually more related to anesthesia than anything else. And if you’re now going to be older, if you now may have accumulated another medical problem like diabetes or hypertension or angina, chest pain, heart attack, things like that, you’re not going to get less risky; you’re going to get more risky over time.
Remember you’ll never be younger, you’ll never be more healthy.