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Surgical treatment of trigeminal neuralgia (tic doloureux) and glossopharyngeal neuralgia and hemifacial spasm (tic convulsif) including microvascular decompression and differential thermal rhizotomy or stereotactic radiofrequency thermal lesioning.
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Percutaneous Stereotactic Radiofrequency Thermal
Rhizotomy for the Treatment of Trigeminal Neuralgia

{To the Trigeminal Neuralgia Page with information and links regarding hemifacial spasm, glossopharyngeal neuralgia, and trigeminal neuralgia. }
Trigeminal neuralgia, often called tic douloureux, is a craniofacial pain disorder characterized by paroxysms of severe, sharp, lancinating, "electric-like", bolts of pain. Trigeminal neuralgia is either classic / idiopathic (primary) or due to a structural lesion involving the trigeminal system (secondary). Classic / idiopathic trigeminal neuralgia typically occurs in persons over the age of fifty, is more common in females, is predominately unilateral, often has tactile "trigger" areas, and does not produce sensory loss (numbness). The pain attacks can occur spontaneously or can be triggered by a stimulus to the skin, intraoral mucosa and very often the teeth. Many patients initially are evaluated by dentists, oral and maxillofacial surgeons, primary care physicians and neurologists before being referred to a major academic medical center with a multi-disciplinary pain group.

The Massachusetts General Hospital Departments of Neurological Surgery, Oral and Maxillofacial Surgery and Anesthesiology have designed a methodical approach to the diagnosis and treatment of craniofacial pain disorders and in particular, trigeminal neuralgia. A comprehensive medical evaluation is first performed including the appropriate diagnostic testing. Imaging studies are employed to evaluate for the presence of a tumor, blood vessel abnormality or multiple sclerosis which might be damaging the trigeminal system. The first line of treatment to help relieve the pain is usually medical therapy, with drugs such as carbamazepine (Tegretol), baclofen (Lioresal), phenytoin (Dilantin) or clonazepam (Klonopin). However, very often, these medications do not eliminate the pain and / or can produce significant side effects which can be disruptive to the functions of daily living or could be potentially harmful. If medical therapy is unsuccessful, surgical procedures can be performed to eliminate the pain.

Percutaneous Stereotactic Differential Radiofrequency Thermal Rhizotomy is a surgical procedure that was developed in the 1960's and has been modified by physicians at the Massachusetts General Hospital for the treatment of trigeminal neuralgia. This procedure creates a precise thermal lesion of the trigeminal nerve which interrupts the transmission of pain signals to the brain, while preserving touch sensations of the face. Radiofrequency Thermal Rhizotomy does produce some mild numbness of the face in the region of the pain, which is usually quite tolerable. It does not effect the nerve function to the muscles of the face, therefore facial paralysis is not a concern.

Dr. Ernest S. Mathews (Neurological Surgery), Dr. Steven J. Scrivani (Oral and Maxillofacial Surgery), Dr. Fred DeBros (Anesthesiology) and Mr. Terry Picard (Radiology) perform this procedure with a technique which allows the surgeons to perform nerve testing and thermal nerve lesioning with continuous radiographic imaging and most importantly, maximum patient comfort. This procedure is performed as outpatient day surgery; patients are admitted on the morning of the procedure and can usually be discharged by the early evening. Our patient series has successful pain relief which is comparable to other centers in the country, while experiencing minimal complications and side effects.
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