University of Virginia Health System

UVA'S GAMMA KNIFE OFFERS RELIEF FOR TRIGEMINAL NEURALGIA

It is universally considered to be one of the most painful afflictions known in medicine - even more painful than childbirth. Something as simple as washing your face or eating can trigger an attack of intense, stabbing, electric shock-like pain in the area of the face for minutes or hours. This disabling condition is called trigeminal neuralgia and for Jean Johnson of Front Royal, Va., the pain was unbearable.

It doesn't cause death, but it is excruciatingly painful. I'm just getting to the point where I don't cry or tear up because of the pain I felt, Johnson said.

The first signs of trigeminal neuralgia most commonly occur in persons over the age of 50, and affect women more often than men. Johnson's doctors couldn't identify the cause of her pain. She was tested for Lyme's disease, heart failure, stroke and impacted wisdom teeth. Finally, after a year of undergoing a battery of tests with no results, Johnson came to Dr. Neal Kassell, professor of neurosurgery at the University of Virginia Health System, who quickly diagnosed the condition and offered a unique treatment - knifeless surgery.

Kassell recommended the gamma knife, a relatively new treatment for trigeminal neuralgia although it has been used for years to treat brain tumors, arteriovenus malformations and even Parkinson's disease without having to make an incision. U.Va. has the only gamma knife in the state of Virginia and Kassell's colleague at U.Va., Dr. Ladislau Steiner, helped develop the instrument several decades ago. According to Kassell, the gamma knife works by focusing high-energy gamma rays from a Cobalt source on one specific area of the brain.

If you can imagine something that looks like a football helmet that has 201 sources of gamma rays where all the gamma rays converge at one point, it will destroy any and all the tissue at that point, Kassell said. But each individual beam, will, in and of itself, not harm the brain or other structure. The way it works for the trigeminal neuralgia is we focus gamma radiation on the nerve as it enters the brain - the nerve that goes to the face that carries sensation - and it changes the conduction of nerve impulses and it eliminates the pain.

The procedure worked for Johnson, who has not had a recurrence since the treatment nearly a year ago.

It has given me life, pain-free. I would tell others that if they are suffering from trigeminal neuralgia, that this is the route they should definitely go, Johnson said.

According to Kassell, the long-term results of this treatment for trigeminal neuralgia are not known because it is a new treatment for this disorder.

More than 10,000 people with the disorder are listed in the national Trigeminal Neuralgia Association's (TNA) database, but that's only people who know about the association.

Trigeminal neuralgia is not a rare disorder, said Claire Patterson, president of the TNA. However, there is not a current census of people who are afflicted. The last official count occurred 25 years ago and it was reported that one in 25,000 people had the disorder.

February 7, 2002