I am trying to decide if I should have the balloon rhizotomy. Is there any post surgical pain or phantom pain after surgery?the shocks I am experiencing now are not persistent. One is constant, never stops.that one is not shock like . Just pain…anyone have advice for me…to help me decide if I should undergo the
procedure?
David, I can't tell you whether or not you should undergo the surgery (or any other). I can share the observation that in the published papers I've read over several years, balloon compression Rhizotomy seems to be somewhat less reliable and less persistent in alleviating chronic neurological face pain than RF Rhizotomy. When rhizotomy is not successful, there can be persistent and elevated levels of break through pain. "Phantom" pain is sometimes an alternate term for what might be called more accurately "deafferentiation" pain, when the central nervous system loses track of its peripheral sensing elements and starts signalling frantically to find them again. That can be a very difficult form of pain to treat or manage.
The decision to have rhizotomy is generally grounded on two factors: are medications no longer effective (and has a full spectrum of trials in medication been conducted with careful observation) and (2) are you considered not to be a candidate for MVD for some reason? No procedure is as effective for the constant underlying pain of atypical TN, relative to effects on typical lightning-shock TN. And stereotactic radiosurgery (Gamma Knife, Cyber Knife) is less persistent, with at least half of all successful patients relapsing within three years. GK and CK appear to be falling out of favor in facial neuralgias during the past few years.
Some others on this site might suggest that you also try non-invasive physio-therapy procedures for presumed compression of the trigeminal nerve roots in the cervical spine, before attempting any invasive surgical procedure. I haven't personally seen convincing medical evidence for effectiveness of such an approach, but other than delaying more effective therapy, I doubt that it will cause additional injury.
Regards, Red
Richard A. "Red" Lawhern said:
David, I can't tell you whether or not you should undergo the surgery (or any other). I can share the observation that in the published papers I've read over several years, balloon compression Rhizotomy seems to be somewhat less reliable and less persistent in alleviating chronic neurological face pain than RF Rhizotomy. When rhizotomy is not successful, there can be persistent and elevated levels of break through pain. "Phantom" pain is sometimes an alternate term for what might be called more accurately "deafferentiation" pain, when the central nervous system loses track of its peripheral sensing elements and starts signalling frantically to find them again. That can be a very difficult form of pain to treat or manage.
The decision to have rhizotomy is generally grounded on two factors: are medications no longer effective (and has a full spectrum of trials in medication been conducted with careful observation) and (2) are you considered not to be a candidate for MVD for some reason? No procedure is as effective for the constant underlying pain of atypical TN, relative to effects on typical lightning-shock TN. And stereotactic radiosurgery (Gamma Knife, Cyber Knife) is less persistent, with at least half of all successful patients relapsing within three years. GK and CK appear to be falling out of favor in facial neuralgias during the past few years.
Some others on this site might suggest that you also try non-invasive physio-therapy procedures for presumed compression of the trigeminal nerve roots in the cervical spine, before attempting any invasive surgical procedure. I haven't personally seen convincing medical evidence for effectiveness of such an approach, but other than delaying more effective therapy, I doubt that it will cause additional injury.
Regards, Red
Thank you for your reply Red, I am a candidate for the MVD and I may decide on that procedure . My surgeon has done many of these surgeries and is confident she can do the procedure with very few side effects. She is the only neurosurgeon who has found the vein that is rubbing on the nerve by taking the MRI from the feet up…I have been suffering with this for over 20 years and just want to make the right surgical decision…
Will you explain “from the feet up?” May I ask your surgeons name and location?
I meant from the chin up…it gave a different perspective and the vein became visible. My surgeon is in Halifax,Nova Scotia,Canada and her name is Pickett
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Will you explain “from the feet up?” May I ask your surgeons name and location?
I woke up in worse pain than when I went in, as well as awoke with a fourth nerve palsy that required me to wear an eye patch for a few months.
I think non invasive physio is a good option to pursue for anyone with TN, before surgical procedures. Of late there has been an increase in discussion of autoimmune causes which often impact the neck/ cervical spine, Physio for this kind of complaint can be possibly beneficial even if it doesn't address the underlying cause. Symptomatic relief without drugs is probably a plus.
Richard A. "Red" Lawhern said:
David, I can't tell you whether or not you should undergo the surgery (or any other). I can share the observation that in the published papers I've read over several years, balloon compression Rhizotomy seems to be somewhat less reliable and less persistent in alleviating chronic neurological face pain than RF Rhizotomy. When rhizotomy is not successful, there can be persistent and elevated levels of break through pain. "Phantom" pain is sometimes an alternate term for what might be called more accurately "deafferentiation" pain, when the central nervous system loses track of its peripheral sensing elements and starts signalling frantically to find them again. That can be a very difficult form of pain to treat or manage.
The decision to have rhizotomy is generally grounded on two factors: are medications no longer effective (and has a full spectrum of trials in medication been conducted with careful observation) and (2) are you considered not to be a candidate for MVD for some reason? No procedure is as effective for the constant underlying pain of atypical TN, relative to effects on typical lightning-shock TN. And stereotactic radiosurgery (Gamma Knife, Cyber Knife) is less persistent, with at least half of all successful patients relapsing within three years. GK and CK appear to be falling out of favor in facial neuralgias during the past few years.
Some others on this site might suggest that you also try non-invasive physio-therapy procedures for presumed compression of the trigeminal nerve roots in the cervical spine, before attempting any invasive surgical procedure. I haven't personally seen convincing medical evidence for effectiveness of such an approach, but other than delaying more effective therapy, I doubt that it will cause additional injury.
Regards, Red