Penn Gamma Knife Center at Pennsylvania Hospital
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Acoustic Neuroma

Arteriovenous Malformation

Astrocytoma

Brain Metastasis

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Trigeminal Neuralgia

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Q&A Sessions: Trigeminal Neuralgia

John Y.K. Lee, MD, Assistant Professor of Neurosurgery, is the Director of the Penn Center for Cranial Nerve Disorders and a national leader in treating cranial nerve disorders.

Stacey asks:
I have been diagnosed with trigeminal neuralgia. CT and MRI show no tumors, cysts or anything pinching the nerve. Are there treatment options other than medication when the cause is unknown?

Dr. Lee responds:
Yes, I perform microvascular decompression, percutaneous glycerol rhizotomy, and Gamma Knife radiosurgery as options. I would be happy to see you and discuss these treatment options.

If you would like to schedule an appointment, please call us at 800-789-PENN. You can also request an appointment online.

Tara asks:
I've been treated for migraines for over 10 years. This past month I had a headache that lasted over three days. I went to the emergency room and had a CT scan (the fourth in 10 years). This time they diagnosed me with trigeminal neuralgia. I'm having a hard time finding any doctors to see me because I do not have insurance. Would I benefit from Gamma Knife and is there any assistance in paying for it?

Dr. Lee responds:
Gamma Knife radiosurgery is a good treatment option for patients with typical trigeminal neuralgia. Unfortunately, there is no assistance available to help with the cost.

Pam asks:
I'm scheduled for Gamma Knife radiosurgery. My pain lasts about 2-5 seconds (seems like eternity), but I can feel a bit of a burn afterwards. Does this mean I may have atypical trigeminal neuralgia and that the Gamma Knife radiosurgery may not help? Does this mean I should not do the surgery?

Dr. Lee responds:
This sounds more like typical trigeminal neuralgia. Gamma Knife radiosurgery is a good treatment option for patients with typical trigeminal neuralgia.

Helen asks:
I had the Gamma Knife Surgery almost 2 years ago,but the pain is coming back. Can I have it done again ?

Dr. Lee responds:
Yes, repeat Gamma Knife Radiosurgery for Trigeminal Neuralgia can be successful.

Carol asks:
I have had Trigeminal Neuralgia for 4 years and pain pills do not work any longer. I was told that I have to have a procedure done. It is my 3rd nerve in my face that causes me constant pain. I don't know what procedure to have - gamma knife or microvascular decompression. Which one would be safer and have the least amount of side effects? I'm so confused.

Dr. Lee responds:
Microvascular Decompression provides the longest lasting relief of trigeminal neuralgia symptoms but is more invasive than Gamma Knife Radiosurgery. I would be happy to see you to discuss these options, since I perform a high volume of both procedures and can discuss the relative merits of each. If you have any additional questions or would like to schedule an appointment, please call us at 800-789-PENN. You can also request an appointment online.

Wanda asks:
What is the success rate for the Gamma Knife surgery as it relates to trigeminal neuralgia? Will I still have to take medication once the surgery is done? Currently, I am taking 1600 mg of Neurontin twice a day and 200 mg of Lamictal.

This has stopped working for me the pain in my face has increased. It seems to have affected my nasal cavity. Also, every since I started taking the Lamictal, I have aged. At the age of 50, I look as though I am 60 years old. That should not be. Last year, everyone thought I was at least 38.

Dr. Lee responds:
80-90 percent of patients treated with Gamma Knife radiosurgery for trigeminal neuralgia have good pain relief such that they would repeat the procedure again. The durability of benefit is variable.

Ellen asks:
I have been suffering from trigeminal neuralgia for two years. Right now I am in a fully active state. No food, little or no fluids for two days. My neurologist is out of town and I am on max doses of meds. I would like to have an evaluation from Dr. Lee. How long is the waiting time for an appointment?

Dr. Lee responds:
I would be happy to see you for a consultation as soon as possible, even this week. If you would like to schedule an appointment, please call us at 800-789-PENN. You can also request an appointment online.

I let my scheduling coordinator know to expect your call. Thank you for your interest in the Penn Gamma Knife Center.

Linda asks:
My sister is a trigeminal neuralgia sufferer. Can you give me a ball park cost for the Gamma Knife procedure?

Dr. Lee responds:
Each individual case is negotiated with each insurance provider for reimbursement. Therefore, it is difficult to give an exact figure.

Mary asks:
My sister has trigeminal neuralgia with long episodes often many times per day with severe pain. She is 52 years old and has multiple sclerosis (MS). What are the sucess rates for these patients in general?

Dr. Lee responds:
Success rates for Gamma Knife radiosurgery in MS-related trigeminal neuralgia are approximately 60-70 percent of the success in non-MS patients.

D asks:
My mom has trigeminal neuralgia. She had decompression surgery in 1994, but her pain returned three to four years ago. She had Gamma Knife six months ago and is still taking tegretol. She complains of a tingling sensation in her brain/head following the procedures, and it is still occuring. Is this normal?

Dr. Lee responds:
With time, this should resolve.

Shelly asks:
My doctor recently diagnosed me with trigeminal neuralgia based on my reported symptoms. I had a MRI and CAT scan in 2005 when symptoms first appeared and they were normal. The symptoms disappeared and I have been in remission for three years.

They are now back and much more intensed. I have the burning sensation in the cheek area, lips and the tip of my nose and tongue. I have pain in the jaw even when the burining has subsided. The burning is very prevalent when I am in stressful situations. Am I elegible for the Gamma Knife radiosurgery?

Dr. Lee responds:
Patients with typical symptoms of trigeminal neuralgia tend to respond well to Gamma Knife radiosurgery. Those with atypical symptoms tend to respond less to Gamma Knife radiosurgery.

If you have any additional questions or would like to schedule an appointment, please call us at 800-789-PENN. You can also request an appointment online.

Lisa asks:
I have had trigeminal neuralgia for the past eight years or so and have been on multiple medications over the years and have never been pain free. I have pain all of the time, with burning and jolts that come along with it.

If you have pain all of the time is it more difficult to treat with the Gamma Knife than those that have the intermittent pain? I have heard that the intermittent pain responds better to surgery than the chronic all the time pain.

Dr. Lee responds:
Patients with atypical features of trigeminal neuralgia are generally less likely to respond to any of the surgical treatments, including microvascular decompression, percutaneous glycerol rhizotomy, percutaneous radiofrequency rhizotomy, percutaneous balloon compression, and Gamma Knife radiosurgery.

Nevertheless, it is important to be evaluated by a neurosurgeon with experience in trigeminal neuralgia. I have a special interest in trigeminal neuralgia treatment and would be happy to discuss your options. If you would like to schedule an appointment, please call us at 800-789-PENN. You can also request an appointment online.

Louise asks:
I have suffered with atypical face pain for 14 years. The pain is a constant burn that affects the lips, tongue, gums and an ache that is on the left cheek area. For a long time, Neurontin and Prozac worked. It stopped two years ago. Since then I was put on Lyrica and Cymbalta. That too worked until now. I'm up to Lyrica 150 three times daily, Xanax two times, Cymbalta and Neurontin at bedtime.

I wake up every day in pain and have no energy to fight back. Can you help? Doctors say that surgery is not an option.

Dr. Lee responds:
Patients with atypical features of trigeminal neuralgia are generally less likely to respond to any of the surgical treatments, including microvascular decompression, percutaneous glycerol rhizotomy, percutaneous radiofrequency rhizotomy, percutaneous balloon compression, and Gamma Knife radiosurgery.

Nevertheless, it is important to be evaluated by a neurosurgeon with experience in trigeminal neuralgia. If you would like to schedule an appointment, please call us at 800-789-PENN. You can also request an appointment online.

Carter asks:
Recently I had a dental root canal performed on an upper molar tooth/right side. Immediately afterwards I started to have excruciating pain on the right side of my face, starting in the root canal tooth and progressing upward into the right upper sector of my brain. The pain feels like some one has stuck an ice pick into my brain or like a heavy electrical charge.

Sometimes the pain is like a roman candle firework. The pain sparkles in my mouth area then bursts of pain go off in the upper right side of my brain. This second burst of pain is the worst and can last up to two to five minutes at a time and then repeat itself.

I went to a dental specialist who, over a two day period, did another root canal and then extracted the tooth. The pain has not gone away. I have subsequently gone to a local emergency room three times and last night the ER doctor diagnosed my problem as being "facial trigeminal neuralgia."

I have been taking neurontin 300 mg twice daily and the ER doctor upped the dose to 600 mg BID. The pain medications I have been taking have no effect on the pain regardless of the dosages. The pain is so bad that it causes me to cry out in agony and to scream and to become very despondent, including having suicidal thoughts. The pain weirdly seems to get worse at night around 10 pm.

I can't go on living this way and it's interfering with my work and my living life. Would I be a good candidate for Gamma Knife radiosurgery? Please advise me! Do you pre-screen candidates by phone or in person?

Dr. Lee responds:
Typically, I see patients with trigeminal neuralgia after they have seen a neurologist. These patients have either failed medical management or they cannot tolerate the side effects of medications. A consultation with a neurologist who specializes in treating trigeminal neuralgia is beneficial because there are other medications, such as Tegretol, which may be useful in relieving the pain associated with trigeminal neuralgia.

If medical management is not effective, then neurosurgical options can be discussed. Gamma Knife is one of the three surgical procedures that I perform for patients with trigeminal neuralgia. Microvascular decompression is the preferred strategy for young, healthy patients who want a non-destructive procedure. Gamma Knife is the least invasive procedure among the options.

I would be happy to discuss all of the neurosurgical options with you. Please call 800-789-PENN to schedule an appointment. You can also request an appointment online.

Patti asks:
I have had trigeminal neuralgia for four years on the left side of my face (section two, I believe it is called). The MRI was negative. I have been on Neurontin 3200 mg with no help, I was allergic to Tegretol, and now I'm trying Lyrica and Cymbalta. Baclofen was tried but turned me into a zombie. Do you think I would be a good candidate for Gamma Knife? The pictures really scare me. I am in my 60's.

Dr. Lee responds:
Gamma Knife radiosurgery is effective for patients with trigeminal neuralgia who are not responding to medications or who are having significant side effects from medications.

The procedure itself is often associated with a certain degree of anxiety beforehand, but fortunately we can provide sedation during all parts of the Gamma Knife procedure so that patients can sleep through it. We also provide one-to-one nursing so that patients have a nurse with them at all times throughout the day.

I would be happy to discuss all of the neurosurgical options for trigeminal neuralgia, including microvascular decompression, glycerol rhizotomy, as well as radiosurgery. Please call us at 800-789-PENN to schedule an appointment. You can also request an appointment online.

Cindy asks:
I have a cavernous tumor on both sides. I suffer from headaches and trigeminal neuralgia. I had a pituitary tumor removed 5 yrs, ago. My surgeon said that it's usually inoperable. Would I be a canidate for the Gamma Knife?

Dr. Lee responds:
I would have to review your films, but residual pituitary adenoma can involve the cavernous sinus bilaterally. In addition, the trigeminal nerve resides in the cavernous sinus and can thus cause symptoms. Fortunately, Gamma Knife can be used in these cases.

If you have any additional questions or would like to schedule an appointment, please call us at 800-789-PENN. You can also request an appointment online.

Robert asks:
I have been diagnosed with trigeminal neuralgia. I had decompression surgery which did not work and now I am considering Gamma Knife. What are the side effects?

Dr. Lee responds:
The only side effect is really 5-10% risk of facial numbness/sensory dysfunction. This is usually quite well tolerated and does not mean facial paralysis which is virtually unheard of after Gamma Knife.

Marilyn asks:
I have trigeminal neuralgia. I have not responded to medication and have an appointment with my doctor to discuss my alternatives. I also have severe COPD, pulmonary fibrosis, bronchiectasis, and severe RA. Would I still be a candidate for surgery for TN?

Dr. Lee responds:
Although you have several important comorbidities, Gamma Knife stereotactic radiosurgery should be able to be performed without too much difficulty.

Katie asks:
My 31 year-old husband was recently diagnosed by our family doctor with trigeminal neuralgia. Would you recommend attempting to control the pain with medication and if the results are unsatisfactory to then look into Gamma Knife radiation?

Dr. Lee responds:
Once a patient has failed medication management for trigeminal neuralgia, the surgical options range from open craniotomy and microvascular decompression to less invasive procedure such as the Gamma Knife. Each procedure has its risks and benefits and choice of therapy would be tailored to suit the patient.

Judy asks:
I would like to know if nearly 95 year-old female, with tic douloureux (that is causing severe constant pain; even though on anti seizure medications) would be candidate for cyber knife? She was diagnosed two years ago, had a short remission and now the pain can not be controlled.

Dr. Lee responds:
Gamma Knife is one of the safest and least invasive surgical procedures for trigeminal neuralgia. You would be a great candidate for the Gamma Knife. Indeed, Gamma Knife is the gold standard by which all other radiosurgery tools are compared.

Hawk asks:
I had the trigeminal nerve crushed in 2006. The pain is starting to come back - will the Gamma Knife help me.

Dr. Lee responds:
Gamma Knife is similar to other ablative procedures for trigeminal neuralgia such as percutaneous glycerol rhizotomy, balloon compression, and radiofrequency rhizotomy. It is, however, safer and more reproducible than these other procedures.

Stephen asks:
My son is handicapped, but has been experiencing pain associated with trigeminal neuralgia. Why would I consider Gamma Knife surgery for him when Cyber Knife surgery is now available at two respectable hospitals in New Jersey? From what I've read, the head frame that is used with Gamma Knife is very bothersome to cope with.

Dr. Lee responds:
The precision and accuracy of the Gamma Knife is unparalleled. Indeed, it is the gold standard by which all other radiation therapy devices are compared when evaluating treatments for the brain.

In addition, the frame is a necessary part of the procedure whenever you are delivering such high doses as is necessary for the treatment of trigeminal neuralgia. Because Gamma Knife was designed only to treat brain disorders, it is the best tool for the job.

Mary asks:
I have trigeminal neuralgia, how can you help me and what are the risks, and also what are the long time benefits?

Dr. Lee responds:
Gamma Knife is one of the three surgical procedures that I perform for patients with trigeminal neuralgia. Microvascular decompression is the preferred strategy for young, healthy patients who want a non-destructive procedure. Gamma Knife is the least invasive procedure among the options.

If you would like to schedule an appointment, please call 1-800-789-PENN (7366) or request an appointment online.

Carol asks:
My symptoms are pain in my right eye along with nasal pain on the right side of my face. I have had the pain for about 5 years. I have finally been diagnosed with Trigeminal Neuralgea. I can have pain 100% of the day or 60 to 80% of the day and night. Can the Gamma Knife procedure help my pain?

Dr. Lee responds:
Gamma Knife is often a first option in patients with trigeminal neuralgia. I have a special interest in trigeminal neuralgia and offer multiple different surgical procedures for facial pain, including microvascular decompression, glycerol rhizotomy, Gamma Knife radiosurgery, and peripheral nerve stimulation. Please feel free to contact my office to arrange a visit.

If you would like to schedule an appointment, please call 1-800-789-PENN (7366) or request an appointment online.

Vicki asks:
I have MS and trigeminal neuralgia. Can the Gamma Knife procedure help me?

Dr. Lee responds:
Gamma Knife has definitely been shown to be useful for some patients with multiple sclerosis-related trigeminal neuralgia.

If you would like to schedule an appointment, please call 1-800-789-PENN (7366) or request an appointment online.

Mercedes asks:
I have had trigeminal neuralgia for over 25 years. After experiencing varied degrees of pain I finally found a combination of medications that keep me relatively pain free, with occasional spurts of pain related episodes that last a few weeks at a time, several times a day. I am now 68 yrs. old and don't relish the thought of being on medications for another 25 yrs. Would I be a candidate for Gamma Knife surgery?

Dr. Lee responds:
You would definitely be a candidate for the Gamma Knife. I would be happy to speak with you about the risks and benefits. Please call 1-800-789-PENN (7366) to schedule an appointment. You can also request an appointment online.

Martha asks:
My mother, who is 66 years old, has been suffering from trigeminal neuralgia for the last 12 years, and as of the middle of October, she has had a reocurring episode which had been intolerable to say the least which has led to her decision in trying to seek other alternatives, e.g., surgical procedures.

Based on her recent doctor's recommendations and our own research, we are trying to research more info on the Gamma Knife procuedure, which seems to be the least intrusive. Having read your profile and expertise, I am desperately seeking for your expert advice, and a further recommendation.

Dr. Lee responds:
Gamma Knife is an excellent way to manage trigeminal neuralgia in a noninvasive way. If you would like to schedule an appointment, please call 1-800-789-PENN (7366). You can also request an appointment online.

Clare asks:
My grandmother is terribly claustrophobic, but is having an increasingly difficult time controlling her trigeminal neurolgia with medication. Will she be required to have an MRI and/or a stress test? Does the Penn Gamma Knife Center have the facilities to accomodate her anxiety about those tests if she is required to undergo them?

Dr. Lee responds:
Fortunately, we can provide sedation during all parts of the Gamma knife procedure including the MRI scan. Patients who are claustrophobic are generally given enough medications so that they sleep through the entire MRI and the Gamma Knife procedure itself. In addition, we provide one nurse per patient to help them through this procedure.

Please call 1-800-789-PENN (7366) to schedule an appointment. You can also request an appointment online.

Betty asks:
I read Joann's question. I also have trigeminal neuralgia. I have had this for over a year. I have been taking Gabapentin 800 mg. Initially it worked but now doesn't seem to be very effective. The pain seem more intense and now there is also a burning sensation. I am an insulin dependent diabetic. Does this make a difference? If you feel that I would be a candidate I would like to schedule something as soon as possible. Thank you.

Dr. Lee responds:
Gamma Knife radiosurgery is effective for patients with trigeminal neuralgia who are not responding to medications or who are having significant side effects from medications. I would be happy to discuss all of the neurosurgical options, including microvascular decompression, glycerol rhizotomy, as well as radiosurgery. Please call 1-800-789-PENN (7366) to schedule an appointment. You can also request an appointment online.

Joanne asks:
In reading your questions I am concerned that I have atypical trigeminal neuralgia and thus Gamma Knife will not be effective. I had assumed that my medication was decreasing the frequency of the stabbing pain and I was left with on and off pain that made it difficult to eat, talk etc. What do you think in regards to being a good candidate for Gamma Knife surgery?

Dr. Lee responds:
Patients with atypical features of trigeminal neuralgia are generally less likely to respond to any of the surgical treatments, including microvascular decompression, percutaneous glycerol rhizotomy, percutaneous radiofrequency rhizotomy, percutaneous balloon compression, and Gamma Knife radiosurgery.

Nevertheless, it is important to be evaluated by a neurosurgeon with experience in trigeminal neuralgia. If you would like to schedule an appointment, please call 1-800-789-PENN (7366) or you can also request an appointment online.

Kristy asks:
I have been diagnosed with post traumatic trigeminal neuralgia. I have been told that Gamma Knife radiosurgery is an option. How successful are the ratings on this proceedure for TN?

Dr. Lee responds:
Post traumatic facial pain is usally not responsive to Gamma Knife which is another kind of procedure which damages the nerve to alleviate pain.

Stormy asks:
My neurologist has suggested Gamma Knife to treat my trigeminal neuralgia which has stopped responding to medication. What negative side effects could this have? I'm 29 years old, a mother of three, and very active. I have a high paced job in sales and I'm worried it might cause numbness and affect my speech.

Dr. Lee responds:
Gamma Knife performed appropriately has the lowest rates of numbness compared to any of the conventional ablative approaches for the treatment of trigeminal neuralgia. The only procedure which has a lower rate of numbness is microvascular decompression which is a major neurosurgical procedure.

Gamma Knife radiosurgery should not affect your speech at all. Balloon compression, which is one of the other ablative approaches, has been known to cause a higher rate of jaw muscle weakness.

Overall, most patients prefer Gamma Knife radiosurgery as a treatment for their trigeminal neuralgia than any other approach.

If you would like to schedule an appointment or consultation, please call 1-800-789-PENN (7366) or request an appointment online.

Lyn asks:
My mom is 80 and is having a lot of pain from trigeminal neuralgia. She tried Tegretol, but the side effects were bothersome. She has had an MRI confirming the diagnosis. Do you think she could benefit from Gamma Knife radiosurgery? How long is the procedure, and how much time from first visit until the last follow up?

Dr. Lee responds:
Gamma Knife is a great option for patients with trigeminal neuralgia, especially if they are older. The actual time in the Gamma Knife is approximately 35 minutes. Side effects are minimal.

Sherry asks:
I have been diagnosed with trigeminal neuralgia for eight years now. Currently I am on 2700 mg of gabapentin daily. I have lost faith in my doctors. My pain is definitely brought on by constant stress in my life. I have been suffering from severe sharp attacks at my ear, where my jaw connects. I cannot sleep, I find myself having attack every 5 to 15 minutes. I work with the public and it is very hard to manage these attacks. My insurance is about to end as my job is as well. I need to know, what is the difference between classic symptoms of TN and atypical or post traumatic neuropathic pain? I am not sure what I have.

Dr. Lee responds:
Typical trigeminal neuralgia is episodic, lasts less than 2 minutes, and between episodes the patient is pain-free. There is usually no numbness or neurologic deficit associated with trigeminal neuralgia. In contrast, atypical trigeminal neuralgia is often associated with constant burning pain. Some patients have both a constant, background, burning pain and a more typical episodic, lightning-like pain. Post-traumatic neuropathic pain is also more constant and burning in character. By definition, it comes after a traumatic incident.

I would be happy to assist you. Please call 1-800-789-PENN (7366) or you can also request an appointment online.

Gina asks:
I have read about Gamma Knife surgery for over a year now but am unsure it and how it might apply to me. I was diagnosed with trigeminal neuropathy and tic douloureux 3 years ago after seeing a neurologist and having had an MRI along with other testing. She told me that some places were "doing Botox for this sort of thing" but gave no other guidance. I did not return.

A friend that is a doctor started me on 400 mg of daily Tegretol in September of 2005 only when the sensations no longer seemed bearable. It immediately alleviated the symptoms of facial numbness and tic and the tugging and tightness around my right eye but I eventually required 800 mg a day to control symptoms which is were I remain.

When that no longer helped, my friend suggested a blood test for herpes zoster which came back positive for my having had the virus at one time although the numbers were perfectly borderline for the immediate present and I have never had any lesions. I have experienced no actual pain through this process except for the really only occasional stabbing that is felt in my right ear. She suggested 1200 mg of Zovirax a day which has helped but only in taming the facial sensations. She seems to feel that I need to see a neuro-ophthalmologist at this point but I remain unsure from what type of physician I should be seeking answers and/or help. Can you direct me?

Dr. Lee responds:
There are many appropriate treatment options for patients with facial pain. I would be happy to see you in neurosurgical consultation. If you would like to schedule an appointment, please call 1-800-789-PENN (7366) or you can also request an appointment online.

Sandy asks:
My mother had Gamma Knife for trigeminal neuralgia, a month later she experienced bleeding from the bladder. Her urologist feels this bleeding may be related to the Gamma Knife procedure. Is this possible?

Dr. Lee responds:
I have not heard of hematuria resulting from a Gamma Knife procedure. It is most likely unrelated, but of course, specifics about each case would have to be examined carefully.

Dale asks:
How effective is Gamma Knife for trigeminal neuralgia in MS patients with severe pain?

Dr. Lee responds:
Gamma Knife for trigeminal neuralgia is generally considered about as effective as any of the other ablative approaches, eg. Glycerol rhizotomy, radiofrequency ablation, balloon compression. Unfortunately, results in patients with multiple sclerosis are not as good, but there are still many patients who can benefit. In fact, I have treated several patients with MS-related tic who have been pleased with the results.

Shirley asks:
My question is regarding my husband. He has TN and the pain is in his right side along side of his nose. It has been treated by medication and nothing seems to help. He is 76 - has had open heart surgery and had a stroke in 2001 which was caused by plaque — not a brain hemorrhage. He is in good health and if it were not for the medication for the TN he takes just an aspirin. The pain is becoming intolerable. Is he a candidate for the Gamma Knife?

Dr. Lee responds:
Gamma Knife is a minimally invasive option for patients with trigeminal neuralgia. Based on your description, he is a great candidate for Gamma Knife.

If you would like to schedule an appointment, call 1-800-789-PENN (7366) or you can also request an appointment online.

Pepper asks:
I have atypical trigeminal neuralgia, pain since 1995. Only a few occasions of classic TN, one lasting 16 hours this month. I have had pulsating pain near the right temple since 1995, about 15 times per day since 1995. Pain has always been on the right side. Cannot sleep on the right side of my head since 1995. I cannot wear hats or hair barrettes very often. In the early years, the pain was in jaw and nose and temple (always on the right). Now mostly right temple area. Am I a candidate for Gamma Knife radiosurgery? Is there an excellent clinic close to me in Mississippi?

Dr. Lee responds:
Gamma Knife radiosurgery works best with patients who have "classic" trigeminal neuralgia which is defined as lancinating pain in the distribution of one or more of the branches of the trigeminal nerve. The pain lasts less than two minutes and is stereotypical in its presentation. It is often associated with cutaneous triggers such as lightly brushing the face.

Gamma Knife radiosurgery does not work as well with atypical trigeminal neuralgia or post-traumatic neuropathic pain of the face.

Luv asks:
Ten years back at the age of 19 I suffered from trigeminal neuralgia and underwent Gamma Knife radiosurgery. Now at the age of 29 the TN has reoccured. Kindly suggest the best treatment. Can I undergo another Gamma Knife?

Dr. Lee responds:
Trigeminal neuralgia can be treated by multiple different methods, including ablative approaches such as Gamma Knife radiosurgery, glycerol rhizotomy, radiofrequency rhizotomy, and non-destructive approaches such as microvascular decompression. Repeat radiosurgery can be performed but at a lower dose and higher risk of numbness and bothersome facial sensations.

Lucille asks:
I had Gamma Knife Surgery at in 2003 and I'm starting to have a return of the pain from TN. Can this surgery be performed again?

Dr. Lee responds:
Repeat Gamma Knife radiosurgery for trigeminal neuralgia can be performed a second time, but you should be counseled as to the risks. Doses are generally lowered for the second procedure, and thus efficacy may potentially be affected.

For more information or to schedule an appointment at the Penn Gamma Knife Center, please call 1-800-789-PENN (7366) or you can also request an appointment online.

Tom asks:
I had surgery in 1992 for TN. I did not get total relief from surgery. The pain is coming back and is very painful. Can the Gamma Knife work after already having surgery?

Dr. Lee responds:
The Gamma knife or any ablative surgery can be used to treat recurrent trigeminal neuralgia pain after prior surgical procedure. In fact, in the early days of the Gamma Knife in the United States, it was reserved for patients who had recurrent pain after prior microvascular decompression.

For more information or to schedule an appointment at the Penn Gamma Knife Center, please call 1-800-789-PENN (7366) or you can also request an appointment online.

Mark asks:
I had Gamma Knife radiosurgery for trigeminal neuralgia two years ago. Will the paresthesia (numbness) ever go away?

Dr. Lee responds:
One of the common side effects of any ablative procedure for trigeminal neuralgia is numbness. This can be seen with percutaneous glycerol rhizotomy, percutaneous radiofrequency rhizotomy, percutaneous balloon compression, and gamma knife radiosurgery. In fact, the rate of numbness appears to be the lowest with Gamma Knife radiosurgery.

Usually, the numbness improves over the period of a year; however, in a minority of cases, the numbness persists as in your case. It is definitely possible that the numbness will continue to improve. Unfortunately, we cannot predict which patients will develop numbness.

Shirley asks:
I have trigeminal neuralgia. The pain shoots from the right upper gum to the sinus cavity . Do you use the Gamma Knife on the face or at the base of the trigem at the brain stem? What are the risks?

Dr. Lee responds:
Trigeminal neuralgia is a painful and debilitating disease. There are many treatment options for patients. Gamma Knife is a particularly attractive option, because the surgical risks are low. In general, we target the Root Entry Zone of the trigeminal nerve. We are targeting the nerve at the "base of the trigeminal nerve" as it exits the brainstem and enters the trigeminal ganglion.

The major complications of Gamma Knife for trigeminal neuralgia are the same as other ablative procedures, such as percutaneous glycerol rhizotomy, percutaneous radiofrequency rhizotomy, or percutaneous balloon compression. The major risk is numbness of the face and/or eye. We must constantly balance the risk of numbness with the need to achieve pain relief. Higher doses seem to result in better cure rates, but also seem to cause higher rates of numbness. We will treat each patient according to their individual condition.

If you would like more information or to schedule an appointment at the Penn Gamma Knife Center, please call 1-800-789-PENN (7366) or request an appointment online.

Rich asks:
A very dear friend of mine suffers from atypical trigem. She has undergone several procedures including most recently, a balloon style technique to apparently damage the trigem nerve. It seemed to slightly reduce the pain for a few weeks, but it appears that it is returning.

There have been glycerol/alcohol injections, surgery behind the ear to wrap or insulate the nerve -- yet nothing seems to help this level ten stabbing pain in her face and eye. It is four years now, and her life has been brought to a grinding halt. She is loaded with morphine constantly, which causes nothing more than sleep and stomach disorders. Is there anything new on the medical horizons to effectively reduce the suffering of atypical tgm? She is 45 years old.

Dr. Lee responds:
Atypical trigeminal facial pain is a difficult disorder to treat. Considering the number of procedures that have been tried on your friend, it is prudent not to try another -- Gamma Knife included.

Some treatments on the horizon include motor cortex stimulation which involves an implanted electrode as well as superficial nerve stimulation which also involves an implanted electrode.

If you would like more information or to schedule an appointment at the Penn Gamma Knife Center, please call 1-800-789-PENN (7366) or request an appointment online.

Bobbie asks:
My mother is 72 and has had facial pain for 20 some years. This all started by a dentist removing all her bottom teeth by cutting the molars in fours and than removed them. Since then she has had facial pains and we have been to many places and they have not been able to help her. She was at Penn and was given neuriton for nerves and it worked for a while and now we are back to the pain. The pain is 24/7 and she has just about had it. She also gets alot of sores and if i don't get help for her soon, she will lose it.

Dr. Lee responds:
Facial pain can be caused by a variety of things. If her pain is more typical of trigeminal neuralgia, eg. sharp, shooting, lancinating pain with episodes that last less than two minutes, and in between episodes her pain is gone, or if her pain responded well to Tegretol which is usually prescribed by a neurologist, then she may be a candidate for Gamma Knife radiosurgical ablation.

Please call 1-800-789-PENN (7366) to schedule an appointment. You can also request an appointment online.

Bansi asks:
My dad is suffering from trigeminal neuralgia. He has shooting pain on the right side of cheek, lip and the area around , specially when chewing. He is a non smoker and 55 years old. His weight is 85kg and he is 6 feet tall. He is suffering from TN from the past 4 months. I want to know if Gamma Knife is a permanent solution to the problem of trigeminal neuralgia. I would like to have your email address where I can send you the detailed medical report. Please let me know the best solution to his problem.

Dr. Lee responds:
The most durable procedure for the relief of trigeminal neuralgia is microvascular decompression. This is an open surgical procedure that I recommend for many patients who are 65 years and younger.

Many patients, however, choose Gamma Knife radiosurgery because it is an outpatient procedure with few risks. I would be happy to review his case.

Brad asks:
I have bells palsey and trigeminal neralsia but nothing shows on MRI nor blood tests, what next?

Dr. Lee responds:
I would be happy to see you in consultation.

Barbara asks:
Can you help me? I have a very dear friend who has trigeminal neuralgia and he is suffering. He has a patch between the nerve and the vein in his brain where the nerve was curved because of the vein and this patch was put in in Jan 2005. It was good for two and a half years and then the pain appeared again, even stronger. Can this Gamma Knife procedure help him even if he has this patch? The pain is all the time when he drinks, eats, brushes his teeth, talks, touches between the lips and the nose only on the right side. He is 44 years old. The pain is like a knife which cuts the cheek between the lips and the eyes. Sometimes he feels the pain inside his mouth above the palate. The pain can last 15 or 30 seconds and he can only wait for it to stop. He is taking lyrica 3000 mg 2x a day and has no relief from the pain.

Dr. Lee responds:
Gamma Knife can be an effective procedure for patients with trigeminal neuralgia even after they have undergone the microvascular decompression procedure. I consider it the safest lesioning procedure with efficacy similar to percutaneous glycerol rhizotomy. Its major downside is that the time to onset of pain relief is a median of one month. However, its benefits last about the same as some of the other percutaneous ablative procedures.

 


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Gamma Knife and Leksell Gamma Knife are U.S. federally registered trademarks of Elekta Instrument S.A., Geneva, Switzerland. Photo credits: Susan Pardys, Elekta, Inc.

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