Tony Whitworth, M.D.
Department of Neurological Surgery
UT Southwestern Medical Center
5303 Harry Hines Blvd.
4th Floor, Suite 100
Dallas, TX 75390-9167
214-645-2300
http://www.utsouthwestern.edu/patientcare/doctor/findphysician/profile/0,0,61027_Dr_Louis_Whitworth_MD_&fpSB=lName&fpNR=50&fpJump=0&fpType=&firstName=&lastName=&gender=Any&language=Any&webServiceSlt=Any&webProgramSlt=&clnInterestSlt=Any&searchType=abmsSpeciatly&specialty=A113A&index=9,00.html
Transcript: The three categories of trigeminal neuralgia surgical procedures
With so many treatment options for trigeminal neuralgia, patients often have difficulty deciding which procedure would be best for them. When I counsel my patients about what procedure to consider, I like to break it down into three basic categories.
The first being microvascular decompression which is obviously the most invasive of the procedures but carries with it the highest success rate and the most durability. It also provides patients with the greatest opportunity to completely discontinue all of their medications.
In the next category, I group the percutaneous procedures or the needle procedures. In these operations, a needle is inserted through the cheek up through a small whole in the base of the skull and into the trigeminal ganglion. Once that needle is inserted, a various number of different procedures can be performed to provide pain relief. The first is to inject alcohol or glycerol into the ganglion to kill the nerve. Another option is to heat the tip of the needle up using radiofrequency to burn the nerve. A third option is to insert a small balloon through the needle, inflating it and crushing the nerve. While there are various proponents for each of these procedures, they all essentially work in the same way by creating some degree of neural injury and some degree of facial numbness in an attempt to alleviate the patient’s pain. These procedures are obviously not as invasive as the microvascular decompression but they do carry with them some degree of risk.
The third category that I counsel patients on is gamma knife radiosurgery. This is a non-invasive procedure that uses radiation to treat the patient’s pain. This carries with it the least risk to the patient but also is not the most effective of the treatments.
So I think that when patients are trying to decide which treatment would be best for them, they need to consider what is going to be the most successful verse which carries the most risk and invasiveness. Once they have that information, most patients are able to choose one of the various procedures.