there's a very long list of the causes of facial pain. There are
benign entities such as tumours inside the heads so occasionally there can be
tumours at the base of the skull that can produce the stems of the trigeminal nerve.
There can be multiple sclerosis that can manifest for trigeminal neuralgia so most
patients undergo an MRI at some stage just to make sure these lesions are not present.
In terms of the different causes of facial pain, it's quite important that a patient sees
a neurologist at some stage in their journey, so they can tease out the other possible diagnoses.
It's quite important that we treat patients with gamma knife with a diagnosis of typical trigeminal
neuralgia or typical glossopharyngeal neuralgia and the reason for that is if patients have
atypical facial pain or they have cluster headache which can manifest in a very similar fashion
or if they have neuropathic pain, so rather than the nasty nasty shocks and then nothing and then
the shocks again where are they in neuropathic pain that the pain never really goes away
there can be burning and constant discomfort that tends not to respond to gamma knife.
trigeminal neuralgia can occur in multiple sclerosis, there is a known link. Sometimes we can
actually see on an MRI scan the changes within the brain that are occurring during
the multiple sclerosis and the demyelination, so sometimes there can be a plaque in the brain stem
and that's part of the brain if you imagine between my fingers so it's very deep in the brain
and that's where the facial sensation nerves enter the brain. You can quite often see a plaque or an
abnormality within the brain substance, so unlike the other hypotheses i was speaking about with
typical trigeminal neuralgia of unknown origin, where we think the problem is as the nerve is
interfacing with the brain, in multiple sclerosis often the abnormality is seen within the brain
substance itself. This means that the results from multiple sclerosis treatment and trigeminal
neuralgia can be a bit more unpredictable than in the idiopathic trigeminal neuralgia,
which is important. Historically, the outcomes have been a little bit hit and miss 50/50.
However, more recently the outcomes in literature are much more favorable in reducing the frequency
and severity of the trigeminal neuralgia pain, certainly gamma knife is something that that we
tend to choose in preference to the invasive treatments for multiple sclerosis
as it targets the nerve in a closed head fashion. The patient doesn't need to undergo open head
surgery, it's convenient for patients who may have other disabilities from their neuralgias such as
requiring wheelchairs etc. The practicalities of gamma knife makes things more simple, certainly in
terms of recovery compared to after an operation and the data from multiple sclerosis over the
last five to ten years using Gamma Knife has become much more favourable towards using this.
Number one, the ideal patient to be referred either to the general practitioner or through
their neurologist is someone who's tried medications for trigeminal neuralgia and
it's not been enough, or the medication that causing too many adverse effects. These are
the sorts of patients we can help with the next level of treatment which is the brain procedures;
gamma knife being one of them. In terms of the practicalities, probably the easiest
way is to refer to Queen Square Radiosurgery Centre where I work, and we are the trigeminal
neuralgia gamma knife service for the south of England so I think that would be the easiest
port of call but of course to my NHS or my private secretary depending on on the route of treatment.
People ask whether they'll be left with scars on the face or the head after surgery, but
not after Gamma Knife radiosurgery. So, it's a closed head procedure we don't make any incisions,
we don't open the skull, we don't need to go through the brain to get to our target,
it's what we call incisionless surgery one of one of the zero access treatments we have
what you will be left with for a couple of days are the divots
on each side of the forehead where the frame has been which is the important three-dimensional map
for us to target the nerve but they settle in the three to four days afterwards and fill out.