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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