Download Trigeminal Neuralgia Care Center brochure

of arteries, places a small piece of Teflon padding
between the nerve and artery to prevent contact
with the nerve or, in the case of veins, coagulates
and cuts the veins.
The majority of patients who have this procedure
performed by a qualified neurosurgeon have no
facial numbness and are pain-free, requiring no
further medications. While the Jannetta Procedure
has a high success rate, it also carries some risks,
including a small chance of hearing loss, facial
weakness, facial numbness, double vision, or, in
very rare cases, stroke and death.
Microvascular Decompression (MVD) for
Hemifacial Spasm—The Jannetta Procedure is
proven to be an excellent treatment for hemifacial
spasm. Many cases are initially treated with Botox
injections into the affected muscles; however,
eventually these muscles continue to weaken, and
patients remain with the disfigurement caused
by the facial weakness and hemifacial spasm.
Percutaneous Retrogasserian Glycerol Rhizotomy
(PRGR)—In cases where patients cannot safely
undergo general anesthesia or tolerate the Jannetta
Procedure for trigeminal neuralgia, PRGR is an
excellent treatment alternative.
Chemical rhizotomies of the trigeminal nerve
were first done in 1912, and in 1981 it was
reported that glycerol injection alone provided
excellent pain relief with greatly reduced risk of
facial sensory loss.
Springfield Campus
271 Carew Street
Springfield, MA 01104
Trigeminal Neuralgia—
one of the most painful
afflictions known to medicine.
Patient
Registration
Hemifacial Spasm—
frequent involuntary muscle
contractions on one side
of the face.
Patient & Visitor
Parking
A Place for Expert
Treatment and Relief
From the North: Take Route 91 South to exit 8: Route
291/20 East. Take exit 3: Armory Street. Go through traffic light
and then follow rotary around to the left. At the blinking red
light, turn right onto Armory Street. Follow Armory Street to first
traffic light. Turn left onto Carew Street. Mercy Medical Center is
one-half mile on the left.
From the South: Take Route 91 North to exit 8: Route
291/20 East. Take the first exit, 2B: Dwight Street. Turn left at
the stop sign onto Dwight Street. At the second traffic light, turn
right onto Carew Street. Mercy Medical Center is one-half mile
on the right.
Glycerol rhizotomy is much less likely to cause
sensory loss in comparison with other trigeminal
operations such as radio-frequency rhizotomy.
Immediate or complete relief of pain is achievable
in 90% of patients, with long-lasting pain control
achieved in approximately 70% of patients,
according to recent studies.
A Unique
Neurosurgery
Program…
From the East: Take Route 291 West to exit 3: Armory Street.
Take your first left. At the blinking red light, turn right onto Armory
Street. Follow directions from the north listed above.
For more information, please call
the Trigeminal Neuralgia Care
Center at 413-748-9448.
From the West: Take Route 90/Mass Turnpike East to exit 6:
Route 291 (Springfield/Hartford). At traffic light, turn left onto
Route 291 West (Springfield). Take exit 3: Armory Street. Take
your first left. At the blinking red light, turn right onto Armory
Street. Follow directions from the north listed above.
TGNcare.com
Mercy Medical Center accepts most major insurance plans.
Mercy Medical Center is a member of the Sisters of Providence Health
System and Catholic Health East, sponsored by the Sisters of Providence.
The First of Its Kind
in the Region.
SPHS-2006-162 • 3/07
Stereotactic Radiosurgery—This involves delivering a single dose of radiation to the trigeminal
nerve. It can provide effective pain relief with a
relatively low complication rate.
Our mission is to heal.
Our passion is to care.
Trigeminal Neuralgia Care Center
The Center takes a comprehensive, integrated
approach to the diagnosis and treatment of trigeminal
neuralgia, hemifacial spasm, and other cranial nerve
disorders through the coordinated use of neurology,
neurosurgical and neuroradiological evaluation,
surgical treatment, stereotactic radiosurgery, superb
ICU and hospital care, and perioperative coordination and education.
Patients with trigeminal neuralgia, hemifacial spasm,
and other neurological disorders benefit from modern
diagnostic tools and state-of-the-art neurosurgical
techniques. Special expertise at the Center includes
the use of microvascular surgery.
Definitive Diagnosis, Expert Treatment,
Comprehensive and Coordinated Care
Neurosurgery
Team
State-of-the-Art
Imaging
Supportive
Care
Neurology
Team
Patient
Navigator
(Nurse)
Ancillary
Services
Patient
Medical
Intervention
Trigeminal Neuralgia
Trigeminal neuralgia is universally
considered one of the most
painful afflictions known to medical practice. It is characterized
by episodes of intense,
stabbing, electrical-shocklike pain affecting one side
of the face. Something as
simple and routine as
brushing teeth, eating,
talking, putting on make-up,
or even a slight breeze
can trigger an attack.
In most cases, trigeminal
neuralgia is caused by a
blood vessel compressing
the trigeminal nerve as it
exits the brainstem. In rare
cases, a tumor or other
lesions affecting the trigeminal
nerve can cause trigeminal
neuralgia.
• Comprehensive Neurologic and
Neurosurgical Evaluation
• MRI Testing
• Pre-Operative Evaluation
• Neurosurgery
• Specialized ICU/Hospital Care
• Stereotactic Radiosurgery (XKnife)
• Pre- and Postoperative Care Coordination
Hemifacial spasm is a neuromuscular disorder
characterized by frequent involuntary contractions
of the muscle of one side of the face. It usually
affects the muscles of the eye first, causing some
twitching, and then progresses to force closure of
the eye and a pulling of the mouth to one side of
the face. Very commonly, hemifacial spasm is
caused by a blood vessel pressing on the facial
nerve at the brainstem.
Medications Used to Treat Trigeminal Neuralgia
Middle or 2ND Branch
Maxillary—Upper lip, upper
teeth, upper gum, cheek,
lower eyelid, and side of
the nose.
Trigeminal
Nerve
Hemifacial Spasm
Basically, there are three kinds of treatments
available—medication, surgery, and a combination
of medication and surgery.
Upper or 1ST Branch
Ophthalmic—Eye, eyebrow,
forehead, and frontal portion
of the scalp.
Program Elements
The Trigeminal Neuralgia Care Center at Mercy
Medical Center is one of very few programs in the
nation offering comprehensive treatment options
for this condition.
Treatment Options for Trigeminal Neuralgia
and Hemifacial Spasm
Kamal K. Kalia, M.D.
Medical Director
Trigeminal Neuralgia Care Center
Surgical
Intervention
Initial treatment consists of medication. If medication
prove to be ineffective or if they produce undesirable side effects, there are a number of neurosurgical procedures available with a high rate of success in achieving pain relief.
Lower or 3RD Branch
Mandibular—Lower lip, lower
teeth, lower gum, and side of
the tongue. Also covers a
narrow area that extends from
the lower jaw in front of the
ear to the side of the head.
Artwork: Original appears in “Tips on Hard-to-Manage Pain Syndrome,”
Patient Care—The Practical Journey for Primary Care Physicians, April 1990.
Anticonvulsant Drugs
These are the most common medications used
to treat trigeminal neuralgia. In the early stages of
the disease, the medication controls pain for the
majority of people. However, the medication’s
effectiveness may decrease over time. Side effects
include dizziness, double vision, sleepiness, and
nausea. Anticonvulsant drugs have been very
effective in treating trigeminal neuralgia even though
trigeminal neuralgia is not connected to seizures.
Muscle Relaxants
The effectiveness of muscle relaxants may increase
when used in combination with anticonvulsant medications. Side effects include confusion, depression,
and severe drowsiness. Trigeminal neuralgia often
follows a “remitting and relapsing course” in which
some patients experience pain, have their pain
controlled with medication, and then, after weeks
or months, are weaned off the medication and
remain pain-free.
Surgery
While many people with trigeminal neuralgia
achieve adequate pain control on medication,
others eventually stop responding to medications
or experience side effects. For these people,
surgery may be an excellent option.
In some cases, a combination of
different treatment options may be required
to achieve pain relief.
Surgical Procedures Offered at Mercy
Medical Center Include:
Microvascular Decompression (MVD)—
Also known as the Jannetta Procedure, this was
pioneered by Dr. Peter J. Jannetta and involves
decompressing the trigeminal nerve from blood
vessels in contact with the nerve at the brainstem.
The Jannetta Procedure does not damage or
destroy the trigeminal nerve. It is an operation
done under general anesthesia and commonly
requires two to three days of hospitalization
after surgery.
A small incision is made behind the ear, then
through a small opening in the skull, the trigeminal
nerve is directly inspected with the operating
microscope. The surgeon is able to see arteries
or veins in contact with the nerve, and in the case