April is a 43-year-old wife and mother of two young children. She started to experience left-sided electric shock-like facial pain in approximately November 2006. The pain was primarily located in the left cheek and left jaw region and is aggravated by chewing, laughing, and other facial muscle movement. She had evaluations by several dentists and subsequently had two root canals performed at an attempt to relieve the pain; these procedures did not provide relief.
She proceeded for a neurological evaluation and was diagnosed with trigeminal neuralgia. This condition may arise when a blood vessel causes pressure on the trigeminal nerve, the nerve that controls sensation in the face. She was started on several different medications for pain management. The medications did provide her with some relief; however, she experienced unpleasant side effects from the medication, mainly fatigue. She originally presented to Dr. Antonio DeSalles of the Stereotactic Department of Neurosurgery at UCLA for evaluation. After reviewing her case, Dr. DeSalles recommended that April seek consultation with Dr. Neil Martin for a Neurosurgical evaluation as surgical treatment would provide her with the best chance of pain relief without the use of life-long medications.
April met with Dr. Martin in February 2008. He reviewed a MRI scan that did not show any evidence of a tumor or other pathology that could be causing the pain. There was possibly a looping blood vessel near the area of the left trigeminal nerve. Dr. Martin discussed the treatment options including continuing her current medications, radiosurgery - although this may not provide complete pain relief and she may be left with permanent facial numbness, and finally the microvascular decompression surgery was discussed. She left the office after thorough discussion to consider her options.
April decided to proceed with microvascular decompression. This several-hour open cranial procedure involves microsurgery to move the blood vessel away from the trigeminal nerve. In April's case, there was a looping blood vessel causing compression of the trigeminal nerve. Dr. Martin was able to move the blood vessel away from the nerve and Teflon Felt was inserted to maintain the decompression. She tolerated the procedure well and awakened pain free. She was discharged from the hospital two days later.
She was seen for follow-up at the end of May. She remains pain-free and is not on any of her pre-operative medications. Dr. Martin (and April) are extremely pleased with the results and are hopeful about the prospect of a continued pain-free future.
Jennifer Varma, NP