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  Trigeminal Neuralgia  
Trigeminal Neuralgia
Trigeminal neuralgia is a disorder in which sudden lightning-like pains strike the face. In its severe form it is regarded as the most excruciating pain that a person can experience. Drug therapy (especially carbamazepine and baclofen) is often effective in relieving the pain, but when medications fail surgical treatment will provide relief in almost all cases. Over 30 patients with trigeminal neuralgia have had surgery at NINS using microvascular decompression operation.

Microvascular decompression (the Janetta procedure) does not result in the numbness associated with a radiofrequency procedure. The vascular decompression operation is a major surgical procedure, which commonly requires 2 to 3 days in the hospital after surgery. After the induction of general anesthesia, the patient is positioned, prepped, and draped for a retromastoid craniotomy. A small (half dollar sized) opening in the skull, allows the superior lateral corner of the cerebellum to be retracted. The trigeminal nerve is easily visualized with the operating microscope. During the operation, a vessel (often the superior cerebellar artery) is usually found compressing the root entry zone of the trigeminal nerve. This vessel is dissected free and padded to prevent recurrent compression. This results in permanent relief of pain, without facial numbness, in the vast majority of cases.
Similar microvascular decompressive surgery has also proven quite successful in the treatment of hemifacial spasm. In this disorder, the seventh nerve is frequently compressed by branches of either the anterior inferior cerebellar artery or the posterior inferior cerebellar artery.

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