Not many patients suffering from trigeminal neuralgia would consider themselves lucky. Universally acknowledged as the most painful affliction known to adult humans, trigeminal neuralgia (or severe facial pain) affects thousands of Americans every year, many of whom do not yet know that help is available. Rodney Blauer, of Marine del Rey, CA, counts himself fortunate for having had trigeminal neuralgia, though. The severe pain that developed in his left jaw in August, 2000, led to the diagnosis of not only trigeminal neuralgia, but also to the accidental discovery – on the opposite side of his brain – of a potentially life threatening type of brain tumor known as an acoustic neuroma.
Because of the seriousness of the acoustic neuroma, Blauer’s doctors at the Skull Base Institute at Cedars-Sinai Medical Center decided to remove it immediately using an endoscopic procedure and leaving surgical treatment of the trigeminal neuralgia for a future time. The acoustic neuroma was removed in November, 2000, and this past October, less than a year later, Blauer returned to the Skull Base Institute to – at last – get relief from his facial pain through another endoscopic procedure known as an Endoscopic Vascular Decompression (EVD).
According to Hrayr K. Shahinian, M.D., Director of the Skull Base Institute, trigeminal neuralgia is a disabling disorder of the fifth cranial (trigeminal) nerve. Pressure on this nerve can cause episodes of intense, stabbing, electric shock-like pain in the face. "The pain we are talking about is excruciating – extremely intense, extremely severe," says Dr. Shahinian. "The shock of it can actually cause a sufferer's head to snap back, or it can immobilize the individual. The pain attacks viciously and without warning and left untreated, tends to worsen over time."
According to Dr. Shahinian, the severe facial pain of trigeminal neuralgia is caused when a blood vessel is in contact with the trigeminal nerve inside the head and is applying pressure to the nerve. Relieving that pressure is a delicate, time-consuming and highly specialized surgical procedure that can take up to four hours. During the minimally invasive endoscopic procedure, skull base surgeons meticulously separate the nerve and blood vessel, then insert a Teflon disk between them. Once that pressure has been relieved, patients often report immediate and complete relief from the pain that had become a part of their lives.
Rodney Blauer was such a patient. “The pain was gone instantly,” he remembers. “From the minute I woke up after the operation, it was gone – completely.”
Looking back, Blauer says if he had known how effective the EVD would be, and how short the recovery time would be, he would have had the procedure long ago. Although he had been on pain medication for the past year, he had reached the point where it was no longer effective.
“You sort of get used to the pain and you don’t realize that it’s taking a toll on you,” he said. “This surgery was like magic. The operation was done on a Monday morning and I went home on Wednesday – pain free.” If I had known how easy it was, I would have done it earlier.”
“This is an extremely unusual situation,” says Dr. Shahinian. “It is possible for a patient to get trigeminal neuralgia on the same side, caused by an acoustic neuroma pushing on the trigeminal nerve, but I have never seen anyone with neuralgia on one side and a tumor on the other.”
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