CNS Neurosurgery    |    Trigeminal Neuralgia: 78-year old retired businessman, still cycles 200 km / wk, wants no facial pain and to be off his Tegretol! Understood. Done.

Trigeminal Neuralgia: 78-year old retired businessman, still cycles 200 km / wk, wants no facial pain and to be off his Tegretol! Understood. Done.

So, this is the oldest (new age ‘young retiree’) trigeminal neuralgia (aka ‘tic’ facial pain) patient that I have operated in my years of doing this beautiful operation. He is fit and active, and told me he had done a ‘tonne of research’ on his condition and his options before traveling to us in Sydney from interstate to have his microvascular decompression (MVD) microsurgery done. He is now pain-free and discharged from hospital less than a week post-op. I hold on to my MVD patients for a few extra days while they get bedside physiotherapy to become independent before leaving the hospital. The only thing that matters is their outcome.

Vascular loops of the superior cerebellar artery are seen touching and irritating the trigeminal nerve (TN). The brainstem’s root entry zone (REZ) for the trigeminal nerve and adjacent facial nerve (FN) are seen. This view is magnificent to a neurosurgeon.

Peri-operative patient safety is our priority and achieved through:

  • Temporary lumbar drain placement for brain relaxation (to avoid use of any brain retractor);
  • Meticulous patient positioning (this can take up to an hour for me and my team, but the time and care investment pays dividends);
  • Neuronavigation ‘brain GPS’;
  • Intraoperative real-time nerve monitoring (brainstem; 5, 7, 8/BAER), MEP, SSEP);
  • Optimal microsurgical technique (I learned that from the U.S. grandmasters I trained under for many years, Doctors Fred Meyer, Dave Piepgras and Robert Spetzler)
  • Post-operative ICU care (min. one night)
The left panel above shows the trigeminal nerve (TN) of this patient being tested with a nerve microstimulator electrode. Some surgeons have operated inadvertently on the facial nerve (FN) next to it, so it’s always a good idea to use whatever technology is available to double-check. The right panel shows the offending vessels have been miscrosurgically moved away from the trigeminal nerve (TN) and then kept away with small buttresses of teflon felt (PTFE), glued into place for longevity. The whole operation is done through a small incision behind the ear and a craniotomy that is the size of a small coin. The skull is reconstructed here afterwards.

For more information on MVD, CLICK HERE for text and video links.