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Despite traditional superstitions about Friday the 13th, that particular day was a lucky one for Arlington, Tenn., resident Jerry Beach. On April 13, 2012, she underwent surgery by Semmes-Murphey neurosurgeon Dr. Madison Michael, and woke up pain-free after months of suffering. The surgery took place at Methodist University Hospital's Brain and Spine Institute.
Beach, 69, was diagnosed with a condition called trigeminal neuralgia, which presents as sharp, stabbing pains in the face. As Beach describes it, “I was in pretty sorry shape when I went in to see Dr. Michael. I had been experiencing pain in my upper and lower teeth, jaw and right ear back in September. Then, with a second episode, the pain involved my tongue. It was persistent pain that was almost unbearable.”
The painful symptoms of trigeminal neuralgia are caused by a blood vessel pushing against the trigeminal nerve, which carries facial sensations and is involved in chewing. As blood is carried through the artery with every heartbeat, the vessel pulses against the nerve, causing the excruciating pain. There are no risk factors, but the condition occurs most often in people over the age of 50.
“It’s not as uncommon as you might think, with cases happening in about one in every 15,000 people,” Dr. Michael said. The condition is most prevalent in older people because as part of the aging process, the arteries supplying the brain continue to grow and elongate. In some people, an elongated artery starts bumping against the nerve, causing the pain, which can worsen over time. Because of the facial pain symptoms, the condition is often treated initially as a dental or jaw problem (such as TMJ) before the patient comes into a neurosurgeon’s office, he added.
Triggers of the unpredictable bouts of pain can include chewing, or any activity that applies pressure to the face, from shaving to cold wind hitting the face, Dr. Michael said. “Another name for the disease is the ‘suicide disease,’ because a certain number of people will suffer with pain that’s so great and unpredictable, that they’ll do just about anything to make sure it doesn’t happen.”
Once diagnosed, treatment for trigeminal neuralgia can begin with medication. “The medicine will work, but often it’s a question of how long,” Dr. Michael said. “I’ve had patients who’ve enjoyed pain relief for 10 years, and some may only get relief for a couple of months. A significant number of people will ultimately need to move on to another treatment option, which can be surgery, injections to the facial nerve, or gamma knife radiation.”
In the surgical option, an incision is made in the skull behind the ear, and a quarter-inch long Teflon pad called a Teflon pledget is inserted between the nerve and the artery. The pad stays permanently and acts as a buffer between the nerve and the artery. “The expectation is that 9 out of 10 people will have pain relief after surgery, and it’s most often immediate,” Dr. Michael said.
Dr. Michael completed a surgical fellowship with one of the world’s leading neurosurgeons in Bristol, England, who performed about five trigeminal microvascular decompression surgery cases each week. “This is without a doubt one of the pathologies that can be cured. The surgery is safe with low morbidity, and the results are excellent. You can take a person who’s experiencing a serious reduction in quality of life because of the pain, and after the surgery, see them go back to a full life with family and friends.”
Speaking a week after her surgery, Beach was grateful for the relief she has experienced.
“I am doing very well. After the surgery, the pain relief was immediate. When I woke up, I was expecting to see half my head shaved, but the area was very small, and most people wouldn’t even notice it. Of course, there’ll be some time for the surgery site to heal, but I can do nothing but sing the praises of Dr. Michael and his staff. It was just the most fantastic thing.”
Methodist University Hospital is a 669-bed academic medical center in Memphis, Tenn., and houses one of the largest neuroscience programs in the country. The Methodist University Hospital Brain and Spine Institute offers comprehensive clinical adult programs, centers and services to treat brain tumors, skull base tumors, spinal disorders, stroke and other conditions.