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How Effective Is Gamma Knife Surgery For Trigeminal Neuralgia?
Question: I have been suffering from Trigeminal Nuralgis for the past 8 years. It goes up and down in intensity. some time it will go away for a few months, then it comes back.
I am tired of dealing with it. my question is should I try the gamma knife technology , or do you suggest some other procedure to resolve this debilitating pain.
Carbamazopine does make me kind of groggy and sleepy so I take more of it when I have a bad day of attacks.
The only thing that helps is when I get in to a hot tub, I can't figure out why it does help yet.
I am tired of dealing with it. my question is should I try the gamma knife technology , or do you suggest some other procedure to resolve this debilitating pain.
Carbamazopine does make me kind of groggy and sleepy so I take more of it when I have a bad day of attacks.
The only thing that helps is when I get in to a hot tub, I can't figure out why it does help yet.
Brief Answer:
Surgery should be the option only if medicines fail.
Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
The rule of thumb in treatment of Trigeminal neuralgia is that surgery should be considered only if medicines fail to provide adequate relief.
The above fact is based on the logic that even the surgeries of Trigeminal neuralgia-be it Gamma knife or Microvascular decompression,do not provide a permanent cure and more often than not,symptoms recur after one or few years.In most of the cases,repeat surgery is needed.
(Still,out of these,microvascular decompression is known to have long lasting benefit.)
So, till the times, patient gets benefit on medicines,one should continue with medicines.
If carbamazepine is getting you sedated,you may consult with your treating neurologist to put you on oxcarbazepine or gabapentin therapy and observe for the response if these drugs suit you better.
If you have some further questions,I shall be glad to have you in follow-up.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Surgery should be the option only if medicines fail.
Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
The rule of thumb in treatment of Trigeminal neuralgia is that surgery should be considered only if medicines fail to provide adequate relief.
The above fact is based on the logic that even the surgeries of Trigeminal neuralgia-be it Gamma knife or Microvascular decompression,do not provide a permanent cure and more often than not,symptoms recur after one or few years.In most of the cases,repeat surgery is needed.
(Still,out of these,microvascular decompression is known to have long lasting benefit.)
So, till the times, patient gets benefit on medicines,one should continue with medicines.
If carbamazepine is getting you sedated,you may consult with your treating neurologist to put you on oxcarbazepine or gabapentin therapy and observe for the response if these drugs suit you better.
If you have some further questions,I shall be glad to have you in follow-up.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Panwar,
I also had an MRI done and please read the result:
INDICATION: Right-sided trigeminal neuralgia. Evaluate for mass of
arterial loop.
TECHNIQUE: Multiplanar multisequential MR imaging of the brain was
performed with special reference to the trigeminal nerves.
Additionally, 3-D time-of-flight MR angiography of the circle of
Willis was performed.
FINDINGS:
BRAIN:
There are patchy areas of T2 prolongation in the periventricular
white matter compatible with ischemic gliosis on the basis of
small-vessel disease.
There is no evidence for territorial infarct or parenchymal
hemorrhage. No extra-axial fluid collections are identified.
There is no evidence for mass, abnormal signal or abnormal
enhancement along the course of the trigeminal nerves.
3-D TIME-OF-FLIGHT MR ANGIOGRAPHY OF THE CIRCLE OF WILLIS:
There is no evidence for aneurysmal dilatation or stenosis. There is
no evidence for mass effect upon the cisternal portions of the
trigeminal nerves related to adjacent arterial structures; however,
there are small veins identified along the medial margin of the
cisternal right trigeminal nerve and superior margin of the cisternal
left trigeminal nerve.
IMPRESSION:
BRAIN:
1. Periventricular white-matter ischemic changes.
2. No mass, abnormal signal or abnormal enhancement identified along
the course of the trigeminal nerves.
CIRCLE OF WILLIS:
1. No evidence for aneurysmal dilatation or stenosis.
2. No arterial impingement of the cisternal portions of the
trigeminal nerves bilaterally.
3. There are small venous structures in the vicinity of the cisternal
portions of the left and right lateral trigeminal nerves. This is of
doubtful significance.
Preliminary result dictated by: URESH S XXXXXXX
Dictated: 5/1/2015 4:32 PM
Dictated by: URESH S XXXXXXX
Dictated: 5/1/2015 5:15 PM
Job: 0000
Since MRI does not show any interference of any major artery with the Trigeminal nerve does this take the surgery out of picture?
Also do you think as stated in the MRI report:
"3. There are small venous structures in the vicinity of the cisternal portions of the left and right lateral trigeminal nerves.
Do you think this may have any effect on this condition? Should I consult a vein specialist od a cardiologist about this?
Are you saying Gabapentin or OxCarbazepine are less sedating than Carbamazopine? Can they be taken along with Carbamazepine?
Another question, what is a good dose or maximum dose for carbamazepine?
What is your theory about hot tub helping with the pain, and why do you think it does!
Thanks
XXXX
I also had an MRI done and please read the result:
INDICATION: Right-sided trigeminal neuralgia. Evaluate for mass of
arterial loop.
TECHNIQUE: Multiplanar multisequential MR imaging of the brain was
performed with special reference to the trigeminal nerves.
Additionally, 3-D time-of-flight MR angiography of the circle of
Willis was performed.
FINDINGS:
BRAIN:
There are patchy areas of T2 prolongation in the periventricular
white matter compatible with ischemic gliosis on the basis of
small-vessel disease.
There is no evidence for territorial infarct or parenchymal
hemorrhage. No extra-axial fluid collections are identified.
There is no evidence for mass, abnormal signal or abnormal
enhancement along the course of the trigeminal nerves.
3-D TIME-OF-FLIGHT MR ANGIOGRAPHY OF THE CIRCLE OF WILLIS:
There is no evidence for aneurysmal dilatation or stenosis. There is
no evidence for mass effect upon the cisternal portions of the
trigeminal nerves related to adjacent arterial structures; however,
there are small veins identified along the medial margin of the
cisternal right trigeminal nerve and superior margin of the cisternal
left trigeminal nerve.
IMPRESSION:
BRAIN:
1. Periventricular white-matter ischemic changes.
2. No mass, abnormal signal or abnormal enhancement identified along
the course of the trigeminal nerves.
CIRCLE OF WILLIS:
1. No evidence for aneurysmal dilatation or stenosis.
2. No arterial impingement of the cisternal portions of the
trigeminal nerves bilaterally.
3. There are small venous structures in the vicinity of the cisternal
portions of the left and right lateral trigeminal nerves. This is of
doubtful significance.
Preliminary result dictated by: URESH S XXXXXXX
Dictated: 5/1/2015 4:32 PM
Dictated by: URESH S XXXXXXX
Dictated: 5/1/2015 5:15 PM
Job: 0000
Since MRI does not show any interference of any major artery with the Trigeminal nerve does this take the surgery out of picture?
Also do you think as stated in the MRI report:
"3. There are small venous structures in the vicinity of the cisternal portions of the left and right lateral trigeminal nerves.
Do you think this may have any effect on this condition? Should I consult a vein specialist od a cardiologist about this?
Are you saying Gabapentin or OxCarbazepine are less sedating than Carbamazopine? Can they be taken along with Carbamazepine?
Another question, what is a good dose or maximum dose for carbamazepine?
What is your theory about hot tub helping with the pain, and why do you think it does!
Thanks
XXXX
Brief Answer:
MRI picture does not take surgery out of consideration.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and providing further details.
Answering your queries pointwise here-
1)Large studies have shown that even if neuroimaging does not show any arterial contact or compression upon the trigeminal nerve,even then surgery has shown good results.So,MRI coming normal does not take surgery out of option.
2)Venous prominence,as mentioned is not causing a compression on trigeminal nerve.So,it does not appear to be pathogenic.A cardiovascular specialist has nothing to do with it.
3)Oxcarbazepine is lesser sedating than carbamazepine and has a better patient tolerability.Gabapentin,though, has a sedative action but may be better tolerable in some individuals.I have mentioned them as alternatives(if you have problem with carbamazepine).If you can continue with carbamazepine and it is effective,there is no need to switch to or add-on a drug.
4)Maximum dose of carbamazepine in Trigeminal neuralgia is 1200 mg/day.
5)Hot tub baths are known to ease off the pain but the exact mechanism how it happens it not clear.
If you still have further questions,I shall be glad to answer else please close the thread,rate it and write a review.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
MRI picture does not take surgery out of consideration.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and providing further details.
Answering your queries pointwise here-
1)Large studies have shown that even if neuroimaging does not show any arterial contact or compression upon the trigeminal nerve,even then surgery has shown good results.So,MRI coming normal does not take surgery out of option.
2)Venous prominence,as mentioned is not causing a compression on trigeminal nerve.So,it does not appear to be pathogenic.A cardiovascular specialist has nothing to do with it.
3)Oxcarbazepine is lesser sedating than carbamazepine and has a better patient tolerability.Gabapentin,though, has a sedative action but may be better tolerable in some individuals.I have mentioned them as alternatives(if you have problem with carbamazepine).If you can continue with carbamazepine and it is effective,there is no need to switch to or add-on a drug.
4)Maximum dose of carbamazepine in Trigeminal neuralgia is 1200 mg/day.
5)Hot tub baths are known to ease off the pain but the exact mechanism how it happens it not clear.
If you still have further questions,I shall be glad to answer else please close the thread,rate it and write a review.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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