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Gamma Knife Treatment for Trigeminal Neuralgia

A nerve disorder, trigeminal neuralgia is characterized by sudden bursts (paroxysms) of face pain that are often triggered by light touch or cold around the mouth or face, or by talking, eating or teeth brushing.

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What to know about trigeminal neuralgia and Gamma Knife treatment:

  • Trigeminal neuralgia is a cranial nerve disorder that causes bursts of intense facial pain. Sufferers may think they have a dental problem before this neurological condition is diagnosed.
  • Medications initially help alleviate the excruciating pain of trigeminal neuralgia. When medications lose their effectiveness, Gamma Knife radiosurgery can provide lasting relief.
  • Gamma Knife is ‘brain surgery without the surgery part.’ Gamma Knife uses highly focused radiation to target a mapped focal point, leaving surrounding tissue unharmed.
  • Gamma Knife for trigeminal neuralgia is a one-time, outpatient procedure under light sedation, with little or no recovery time needed. Patients generally resume activities within a day. Side effects include puffy eyes, and for some, a headache for a day or two.
  • Gamma Knife provides acceptable pain relief from trigeminal neuralgia in most patients. Some experience improvement right away and some find complete relief over the course of many months.
  • Trigeminal pain eventually recurs in about a quarter of people who undergo Gamma Knife treatment. The Gamma Knife procedure may be repeated after a year for those whose pain returns.

What is trigeminal neuralgia?

Trigeminal neuralgia is a disorder of the trigeminal nerve in the skull base that causes sudden bursts of intense face pain. The three branches of the trigeminal nerve run through the upper, middle and lower portions of each side of the face, and more than one nerve branch may be affected. Pain can radiate along the side of the face from the cheek to the lower jaw. Pain can affect the lips, tongue, teeth and gums, and may be mistaken for dental pain. Trigeminal nerve pain can be triggered by light touch or cold around the mouth or face, or simply by talking, eating, or brushing teeth. While trigeminal pain is usually limited to one side of the face, about 10 percent of sufferers have pain on both sides of the face.

Who gets trigeminal neuralgia?

Trigeminal neuralgia is a fairly rare neurological condition that is difficult to diagnose. About 15,000 people are diagnosed with trigeminal neuralgia each year. Trigeminal neuralgia is most common in women and people over age 40, but it can strike adult men and women of any age. At South Sound Gamma Knife, we have treated trigeminal neuralgia patients from ages 21 to 95.

What causes trigeminal neuralgia?

The causes of trigeminal neuralgia are generally not known. A tumor or blood vessel pressing on the trigeminal nerve (the fifth cranial nerve) may cause a low percentage of cases.

What does trigeminal pain feel like?

Many of those affected describe trigeminal pain as an electric shock, or a bolt of lightning. Everyone agrees: the pain of trigeminal neuralgia is excruciating and unbearable.

How long does a pain episode last?

Debilitating pain spasms may last just a few seconds to several minutes, and may come in frequent waves. Patients never know when they will experience an episode of trigeminal neuralgia pain.

How is trigeminal neuralgia treated?

Anti-seizure medications, such as carbamazepine (Tegretol), effectively control pain for a period of time, but they include many side effects. When medication is no longer effective, there are other treatment options for trigeminal neuralgia, but in general, they are invasive, pain relief can be short-term and may last for just a few years, and side effects can include permanent facial numbness or other damage. Leksell Gamma Knife is an effective, lasting, minimally invasive treatment for trigeminal neuralgia with few or no side effects. We call it ‘brain surgery without the surgery part.’

What are the side effects of Gamma Knife for trigeminal neuralgia?

Most patients do not have any side effects from Gamma Knife treatment. Facial sensations are usually preserved, but about 20 percent of patients will experience some level of facial numbness. There have been recorded instances of patients experiencing a flare in their trigeminal neuralgia pain even after treatment is complete. One side effect common with every patient is that the numbing medication will pool around the eye sockets and cause puffiness of the eyes. This is not harmful; it doesn’t hurt, and will reabsorb within a few days. Ice packs help!

What is Gamma Knife treatment for trigeminal neuralgia?

Gamma Knife targets the fifth cranial nerve at the skull base to interrupt pain signals to the brain. Gamma Knife uses magnetic resonance imaging (MRI) and pinpoint computer mapping to send a high dose of radiation to a highly defined target—while leaving surrounding healthy tissue unharmed.

Does insurance cover Gamma Knife treatment for trigeminal neuralgia?

Every Gamma Knife procedure is authorized by a patient’s insurance carrier before treatment is scheduled. However, because every plan is different, the out-of-pocket expense—the patient portion—will vary. Our team can review your specific coverage. Call our South Sound Gamma Knife office and we will connect you with the best person to help. You can also review our Insurances we accept.

Do I take my trigeminal neuralgia medications the day of Gamma Knife treatment?

Yes. It can take time for the Gamma Knife radiation treatment to become effective, so we want you take your TN medications as usual. We discuss this further in your preadmission appointment with the GK nurse.

What is the recovery like from Gamma Knife treatment for trigeminal neuralgia?

There is no recovery time as Gamma Knife is minimally invasive treatment. Patients do receive conscious sedation, so we encourage rest the day of treatment after discharge. A few patients will have a headache or minor pain for a day or two at the four pin sites where the frame was anchored in position on the head, but most patients are able to resume normal daily activities within 24 hours.

When can I stop taking my trigeminal neuralgia medications?

After Gamma Knife treatment, patients begin a follow-up schedule with their radiation oncologist, neurosurgeon and neurologist. Once it is determined that the Gamma Knife treatment was effective, patients work with their neurologist to start a taper off trigeminal neuralgia medications. This could be as early as six months post-treatment to even years later.

How long does it take for Gamma Knife for trigeminal neuralgia to work?

Gamma Knife provides acceptable pain relief for about 85 percent of patients. The average response time for patients having Gamma Knife treatment for trigeminal neuralgia pain is one to three months. However, some patients will notice a response right away, and some may find it can take up to one year to experience complete relief from trigeminal neuralgia pain. The best results with Gamma Knife occur when it is the first procedure chosen once medication is no longer effective, before other damaging procedures have been tried.

What about recurrence of trigeminal neuralgia after Gamma Knife?

About 30 percent of patients who have Gamma Knife for trigeminal neuralgia report a recurrence of their trigeminal pain.

Can I have Gamma Knife treatment more than once?

If patients do not experience full relief from trigeminal neuralgia after one year, Gamma Knife treatment may be repeated. This is a decision for patients to make with their neurosurgeon and radiation oncologist team.
Learn more about What to Expect During Gamma Knife Radiosurgery.

Gamma Knife relieved Carla's debilitating trigeminal neuralgia pain.

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Marilyn no longer suffers facial pain, thanks to Gamma Knife treatment.

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