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Microsurgery  relieves debilitating facial pain of MUSC patients The excruciating facial pain associated with trigeminal neuralgia abruptly interrupts patients' lives, limiting basic movements such as eating and talking. Typically diagnosed in people older than 50, the stabbing pain can occur and remit during a period of weeks, months or years. “It's a menacing disease that can push patients to the brink of suicide,” said Sunil Patel, M.D., assistant professor of neurosurgery. “But it doesn't have to be that way. Early diagnosis and referral can make all the difference.” MUSC's multidisciplinary face pain clinic treats patients with trigeminal neuralgia and other types of acute or chronic facial pain. After an initial evaluation, a patient's treatment plan might involve staff from neurology, radiology, oral surgery and psychology. It's a comprehensive, focused approach to determine the sources of a patient's pain. Frequently, vascular compression of the trigeminal nerve causes the pain associated with trigeminal neuralgia. An anti-convulsant such as carba-mazepine initially controls pain in approximately 75 percent of patients. However, patients who can't tolerate the side effects and breakthrough pain associated with medical management might be good candidates for microsurgery. Patel recommends microvascular decompression for patients with classic trigeminal neuralgia symptoms who haven't had success with medical therapy. During the decompression procedure, a neurosurgeon makes an incision the size of a button hole through the skull, behind the ear, to reveal the trigeminal nerve. The surgeon lifts the offensive artery off the nerve and packs shredded Teflon between the two to cushion the nerve from future compression. Electrophysiological monitoring throughout the procedure ensures that other critical nerves aren't damaged in the process. Patients go home within two days after surgery and return a week later for suture removal. “Improved surgical and imaging techniques make this a simple surgery that produces immediate results,” Patel said. “It's quite dramatic to see patients who have suffered for years, and then become pain-free and medication-free after surgery. Editor's note: The article is reprinted from MDialogue newsletter, a physician liaison program publication.