MGH Main Web
Neurosurgery HomeNeurosurgery HomeNeurosurgery and Affiliates
TN & HFS Center
Neurosurgery Home
- About Us
- Diseases Treated
- Clinical Centers
- Referrals
- People
- Grand Rounds
- Education
- News, etc.
- Publications
- History
- Support Groups
- Links
- Appointments
- Contact Us
- Search NS Web
 
Neurosurgery Web Sites
- Neurosurgery Home
- Research Home
- Residency Home
- Alumni Home
Mass General Hospital Web
 
 

Trigeminal Neuralgia and Hemifacial Spasm Center

Font Size: [+] [-]
 
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.
 
 
The Purpose of this Center is to provide a complete range of services for the diagnosis, treatment and rehabilitation of patients with Trigeminal neuralgia and Hemifacial Spasm. Patients may be referred for consultation only, care in partnership with referring physician, or complete management.

Articles:

Wilkinson HA, Troup EC and Chalpin JP: Broad Spectrum Approach to Trigeminal Neuralgia Therapy. In Raj P, Erdine S and Niv D, Eds.: Management of Pain: A World Perspective II. Bologna, Italy, Monduzzi Press, 1:259-261, 1996.

Wilkinson HA: Trigeminal Nerve Peripheral Branch Phenol/glycerol Injections for Tic Douloureaux. J. Neurosurg., 90:828-832, 1999.

  • Neurosurgeons specializing in the treatment of trigeminal neuralgia and glossopharyngeal neuralgia and informationabout the treatment of these diseases at MGH/Harvard
  • Neurosurgeons specializing in the treatment of hemifacial spasm and information about the treatment of these diseases at MGH/Harvard
Neurosurgical treatment of trigeminal neuralgia (tic doloureux) and glossopharyngeal neuralgia.

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

#########
Neurosurgical treatment of hemifacial spasm (tic convulsif). Treatments available include microvascular decompression and botulinum toxin injection:
#########

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.

#########
Hemifacial spasm/facial nerve links
#########
References on Trigeminal Neuralgia and Hemifacial Spasm
  • 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.
[Neurosurgery Trauma Center]
Appointments or referrals:

Emad N. Eskandar, M.D., Director,
Facial Pain/Trigeminal Neuralgia Center
Neurosurgical Service
Massachusetts General Hospital
Boston, Massachusetts 02114

eeskandar@partners.org
Languages: English, Arabic

Physician Referrals: 617.724.6590
Patient Appointments:
617.724.6590
Fax: 617.724.0339

Fred G. Barker II, M.D.
Phone: 617.724.8772
Fax: 617.724.8769

Harold A. Wilkinson, MD PhD
hwilkinson@partners.org
Contact: Robyn Hamer
Phone: 617-726-3511
Fax: 617-643-4115

Physician Referral:
MGH Neurosurgery
Referral System

Xray pictures courtesy
Dr Eskandar

 

 
Local Emergency
Neurosurgical Hotline

617-277-2381
[Divider]
US News Home
[Divider]
National and
International Referrals
Neurosurgery @ MGH
617-726-8581
[Divider]
Neurosurgical Spine
Referral Line
617-726-8668
[Divider]
Mass General Hospital
HMS
#########
 
Neurosurgical Service
Massachusetts
General Hospital
55 Fruit Street
Gray 502
Boston, MA 02114
NeurosurgeryS @ MGHNeurosurgical Service @ MGHDiagnosis @ MGH
Disclaimer About Medical Information: The information and reference materials contained herein is intended solely for the information of the reader. It should not be used for treatment purposes, but rather for discussion with the patient's own physician. All visitors to this and associated sites from the Neurosurgical Service at MGH agree to read and abide by the the complete terms of legal agreement found at the Neurosurgery "disclaimer & legal agreement." See also: the MGH Disclaimer, the MGH Privacy Policy, and the MGH Interactive Program Disclaimer - Copyright 2010 MGH Neurosurgical Service - All Rights Reserved. System Info Contact: C.Owen
electronswebs Referral@Neurosurgery.MassGeneral.org Neurosurgery@MGH IntraNet MGH Acute Stroke Service
(617) 726-2241 beeper #34282
Neurosurgery @ MGH MassGeneralWeb Partners Health Care Harvard Medical School Neurosurgery @ MGH MassGeneralWeb Partners Health Care Harvard Medical School