Options for Trigeminal Neuralgia Patients
Given America's aging population, the prevalence of trigeminal neuralgia is likely to increase. And given the pain the condition causes and its resistance to long-term cures, offering patients a full menu of treatment options is critical.
It's also helpful for patients to work with experienced clinicians when sorting through their various treatment options. "High volumes matter in that discussion — and in the results patients experience," says UCSF neurosurgeon Edward Chang, M.D.. He notes that UCSF Medical Center manages more than 300 trigeminal neuralgia patients each year.
From Medical Management to Surgical Menu
Medical management at UCSF usually begins with carbamazepine, titrated up from an initial small dose until the patient's pain is relieved. For some patients, gabapentin, baclofen and phenytoin can also be effective.
But medical management is not right for every patient, either because the pain breaks through the medication or because the side effects become too onerous. For such patients, there are multiple surgical options. Each year, physicians at UCSF treat more than 100 trigeminal neuralgia patients using one of the following procedures:
Tailoring Treatment to Patient Needs
"The key is to tailor the treatment," says Chang. "What are the indications, the risks and the needs of the patient, including their willingness and ability to undergo invasive procedures?"
The most invasive procedure, microvascular decompression, is extremely effective at controlling the pain and has the best long-term results, says Chang. While very safe in experienced hands, it may not be appropriate for a patient who poses a higher surgical risk.
In other cases, the severity of symptoms and expectations of the patient determine what to use. Gamma Knife is a great noninvasive alternative, but it can result in facial numbness, and the biological effect may take some time, so if you need relief right away, it may not be the right choice," says Chang.
Thus, the value of a comprehensive center: If one procedure fails or is inappropriate for a patient's need, there are others. "You need backups and you also need smart care coordination, because even with the best treatment, this is a condition that tends to recur," says Chang. "So we partner closely with our community neurology and internist colleagues for long-term pain management. Together, we figure out how to best relieve these really suffering patients."
When to Refer for Trigeminal Neuralgia Surgery
Refer for surgery when:
For more information, contact Dr. Edward Chang at (415) 353-2241.
To contact UCSF Medical Center, visit https://www.ucsfhealth.org/contact_us/index.html.
UCSF Medical Center is located at 505 Parnassus Avenue, San Francisco, CA 94143-0296.
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