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: Surgical options for Multiple Sclerosis patients with trigeminal neuralgia
I do have a significant large number of MS patients in my practice with trigeminal neuralgia. On the MS patients, I am actually looking at two procedures: Gamma Knife as well as glycerol injections. Now if a MS patient shows up in my office in excruciating pain, exquisite, again can not talk and can not eat, I usually encourage more in lines of a glycerol injection. Gamma Knife is also a fairly good treatment, unfortunately both of these procedures seem to have a significantly high recurrence rate. I share that information with my MS patients.
I have had MS patients in whom they have a glycerol injection and then I don’t see them for three, four years sometimes. Unfortunately, there are also patients within six months they might be back. If they have tried the glycerol, this time they might be wanting to try Gamma Knife and vice versa. So it’s very patient, depending on a patient’s condition. How miserable you are with pain. How quick do you want the relief?
Now as I mentioned earlier on, repetition is possible more with glycerol than with gamma. So if you are having a fourth, fifth recurrence you can definitely have that good relief with glycerol again. I have not noticed that with multiple glycerol injections you’re going to have a higher risk of numbness if the procedure is technically done right, accurate with measurements of the cistern.
I have also noticed very interestingly and hopefully will be publishing our data soon that patients who have had Gamma Knife, with or without MS, when they get the glycerol after that for the recurrence, are actually more sensitive. They have fairly good results. So if you’ve had Gamma Knife that doesn’t make you a poor candidate for glycerol. Actually, the results are very good on that. So either one of these two procedures are my procedure of choice.
Now having said that there are some of my colleagues who primarily do Radiofrequency. And for second or third division pain, Radiofrequency could be just as good as glycerol. Again as I said, it depends on the expertise of the surgeon.