Trigeminal Neuralgia and Hemifacial Spasm Center

Operations available include microvascular decompression and differential thermal rhizotomy or stereotactic radiofrequency thermal lesioning, (which was developed at MGH ):

• Fred G. Barker II, M.D.
• Emad N. Eskandar, M.D.

• Fred G. Barker II, M.D.
• Emad N. Eskandar, M.D.
• Link to more information about hemifacial spasm.
• References on Trigeminal Neuralgia and Hemifacial Spasm from Massachusetts General Hospital and Harvard Medical School authors

TRIGEMINAL NERVE BRANCH INJECTION

What is it? A procedure done in the doctor's office that involves inserting a needle into a small sensory (pain transmitting) branch of the trigeminal nerve in a patient's face.

Why is it done? This is done partly as an aid in diagnosing a patient's facial pain problem, but chiefly in an effort to relieve severe facial pain or trigeminal neuralgia. Injecting one of these nerve branches with local anesthetic should produce an area of reduced feeling or numbness from the skin surface or inside the mouth. If this relieves the major portion of the patient's pain, this implies that the nerve branch injected is likely to be a major or important contributor to the patient's pain. Injecting a destructive chemical (phenol, used by the ancient Egyptians to make mummies) usually interrupts functioning of the nerve branch for six months to a year, occasionally permanently, and can provide gratifying relief of face pain. Most patients will obtain many months of pain reduction from a single injection, and a few will obtain permanent relief. Unfortunately some patients will be disappointed by not obtaining a useful degree of relief. If there is only partial relief or if the relief fades, the procedure can be repeated.

How is it done? The patient is not given pre-medication or sedatives (which would interfere with the patient being alert enough to accurately assess the amount of pain relief achieved or to go home safely). Injections are done with the patient lying on his or her back. The skin over the area to be injected is cleansed with an antiseptic, then a local anesthetic (usually Xylocaine) is injected into the skin and along the proposed trajectory of the needle. The trigeminal nerve is so named because it has three branches. One exits below the eyebrow, one from the middle to the cheek and one passes behind the angle of the jaw. Where the needle is placed will be determined by the location of the patient's most severe pain. A local anesthetic is injected around the nerve branch and the patient is asked to observe whether he or she develops numbness and any reduction in the ongoing and troublesome pain. A small amount of phenol is injected before the needle is withdrawn. A Band-Aid is applied and the patient is assessed to be certain that he or she feels well enough to be taken home by a relative or friend.

Harold Wilkinson, M.D.

• Facial Nerve Problems (UIowa)

• The Mount Sinai Journal of Medicine Percutaneous Stereotactic Radiofrequency Thermal Rhizotomy for the Treatment of Trigeminal Neuralgia Ernest S. Mathews, M.D., and Steven J. Scrivani, D.D.S., M.D., D.M.Sc. Abstract - Full Text (pdf)
• Barker FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. Long term outcome after microvascular decompression for trigeminal neuralgia. New England Journal of Medicine 334:1077-83, 1996.
• Barker FG, Jannetta PJ, Babu RP, Pomonis S, Bissonette DJ, Jho HD. Long term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors. Journal of Neurosurg, 84:818-825, 1996.
• Barker FG, Jannetta PJ, Bissonette DJ, Shields PT, Larkins MV, Jho HD. Microvascular decompression for hemifacial spasm. Journal of Neurosurgery 82:201-10, 1995.
• Scrivani S, Mathews ES, Keith D, Slawsby E. Percutaneous Differential Radiofrequency Thermal Rhizotomy for the Treatment of Trigeminal Neuralgia. Journal of Orofacial Pain 1995. Vol 9, No 1.
  

Referrals | Trigeminal/Glossopharyngeal Neuralgia Hemifacial Spasm | Links