K. Singh Sahni, M.D., F.A.C.S.
Neurosurgical Associates, P.C., Richmond, VA
10710 Midlothian Turnpike, Suite 138
Richmond, VA 23235
804-330-4990
http://www.trigeminalneuralgiava.com/dr-sahni.htm
Transcript: Is it really classic trigeminal neuralgia? One neurosurgeon’s perspective
Sometimes it’s very hard to find out if it’s classical pain or not. In some patient who has waited a very long period of time. They now start having more of a constant pain. Similarly, patients who come in after dental procedures, trauma, accidents. It is sometimes very hard when you are the third or the fourth neurosurgeon seeing this patient as to what is the exact etiology. In your heart, you usually know it is not the most classical trigeminal neuralgia. But over the last 25 years, I have found that we’ve been wrong at times. Patients who end up being more of a classical pattern but presenting with a constant pain because they’ve just waited too long or they haven’t had done. What do we do?
I sometimes actually use glycerol as a diagnostic tool also not just therapeutic. What I have done is I’ve taken the patient to the OR for a fluoroscopy. Fully explain to the patient ahead of time, do not expect a miracle. I will give you a very, very low dose and if you end up coming to me within two to three weeks or a month later and say “I’ve had a substantial improvement” that usually tells me that some sort of an ablative procedure may be helpful. And in those cases, then I will go on and give them the choice to have a Gamma Knife or to have a complete course of the glycerol injection. But however this is on very, very limited number of patients.
We don’t just automatically tell patients who are frustrated and have suffered over the years that you have a neuropathic pain and you should just go home and stay on medications. The thing is as a neurosurgeon you try to dig deeper and deeper especially in these traumatic patients, dental procedures, oral and maxillofacial surgery procedures.
You have to continue to offer what you can always keeping in mind that you don’t want to make your patient worse. That means if you are doing an ablative procedure right away like Gamma Knife or Radiofrequency and you think there might be a risk of numbness, it is a bit difficult to do that. You should try not to cause more harm and the one where I do that is if I’m doing a diagnostic study is by giving a very low dose of glycerol and let the patient decide if they like that feeling to make it more permanent.
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