Surgeries:
Trigeminal Glycerol Rhizotomy
Trigeminal Neuralgia is a rare type of facial pain characterised by severe, intermittent, sharp, shooting, electric shock pain which is triggerable by eating, drinking, touch, wind. There is no prior history of injury, shingles or surgery which may cause other types of facial pain. It typically responds to drugs like Tegretol or Carbamazepine and is unlikely to respond to typical pain relieving medications.
There are two general surgical treatments for trigeminal neuralgia which is refractory to medical therapy. The first, microvascular decompression or MVD is discussed previously and involves a craniotomy. The second type involve less invasive treatments to numb the nerve and these can usually be performed as an outpatient surgery.
Glycerol rhizotomy is a minimally invasive percutaneous procedure to provide relief of trigeminal neuralgia pain. It involves injection of glycerol, a colourless, odourless, viscous liquid into the hole where the trigeminal nerve comes out of the skull. It works by causing a gentle inflammation of the trigeminal nerve to block the pain transmission of neuralgia. Performed correctly, it is successful in 90% of patients and can be easily repeated if there is recurrence of pain. It is ideal for patients who may be too frail for cranial surgery, as a less invasive option or when pain recurs following cranial surgery.
Before surgery a CT brain scan and x ray are performed to provide navigation assistance. The procedure is done under intravenous sedation and some local anaesthetic is infiltrated into the cheek. One asleep a poke incision is made in the cheek and the navigation probe is advanced into the Forman Ovale and once the position is confirmed the patient is sat up and 0.4ml of glycerol is injected to cover the nerve.
The patient is woken up and sits up in recovery and can be discharged later that day. Risks of surgery include a small risk of bleeding, infection, excessive numbness of the nerve and remotely stroke or death. Medication can usually be reduced over two weeks and reviewed in 6 weeks.
Trigeminal Glycerol Rhizotomy
Trigeminal Neuralgia is a rare type of facial pain characterised by severe, intermittent, sharp, shooting, electric shock pain which is triggerable by eating, drinking, touch, wind. There is no prior history of injury, shingles or surgery which may cause other types of facial pain. It typically responds to drugs like Tegretol or Carbamazepine and is unlikely to respond to typical pain relieving medications.
There are two general surgical treatments for trigeminal neuralgia which is refractory to medical therapy. The first, microvascular decompression or MVD is discussed previously and involves a craniotomy. The second type involve less invasive treatments to numb the nerve and these can usually be performed as an outpatient surgery.
Glycerol rhizotomy is a minimally invasive percutaneous procedure to provide relief of trigeminal neuralgia pain. It involves injection of glycerol, a colourless, odourless, viscous liquid into the hole where the trigeminal nerve comes out of the skull. It works by causing a gentle inflammation of the trigeminal nerve to block the pain transmission of neuralgia. Performed correctly, it is successful in 90% of patients and can be easily repeated if there is recurrence of pain. It is ideal for patients who may be too frail for cranial surgery, as a less invasive option or when pain recurs following cranial surgery.
Before surgery a CT brain scan and x ray are performed to provide navigation assistance. The procedure is done under intravenous sedation and some local anaesthetic is infiltrated into the cheek. One asleep a poke incision is made in the cheek and the navigation probe is advanced into the Forman Ovale and once the position is confirmed the patient is sat up and 0.4ml of glycerol is injected to cover the nerve.
The patient is woken up and sits up in recovery and can be discharged later that day. Risks of surgery include a small risk of bleeding, infection, excessive numbness of the nerve and remotely stroke or death. Medication can usually be reduced over two weeks and reviewed in 6 weeks.