Treating Trigeminal Neuralgia
new options open with the NovalisTX
For Cheryl Thompson, riding horseback along Colorado trails—sun on her shoulders and a slight breeze on her face—is Heaven on Earth. But last summer, a recurrence of trigeminal neuralgia that defied medication made even that slight breeze excruciatingly painful. "There's a reason this has been called 'the suicide disease,'" she states.
The problem had begun more than five years before, Thompson notes, and having watched her father deal with the condition, she knew the problem was progressive.
With the care of neurologist Michael Ament, MD, however, she had been able to manage the symptoms. Upon the first clues of recurrence—"it felt like a feather touching my cheek"—a new medication regimen was launched. But this one left her so fatigued she could barely function, and short-term memory was becoming a concern.
As fortune would have it, Thompson is a surgical scheduler at InterMountain Neurosurgery and Neuroscience. When she consulted InterMountain neurosurgeon Stewart Levy, M.D., he offered an option with potentially far less downside than traditional open surgery: stereotactic radiosurgery with the NovalisTX with ExacTrac.
St. Anthony Hospital was one of the first medical centers in the region to employ the highly advanced NovalisTx technology. It is now a cornerstone of care at the new St. Anthony Cancer Center, given its ability to deliver radiation therapy treatment two to eight times faster than prior systems. Complementing that superior speed is the Novalis' remarkable ability to target identified tissue (see sidebar).
It's that pinpoint precision that came into play for Thompson's trigeminal neuralgia treatment plan.
Countering the "cross-circuit"
"The actual cause of trigeminal neuralgia is not fully understood," begins Dr. Levy. "We believe the source, in most cases, is the loop of an artery crossing over the nerve and pounding on it to the point of irritation and even possible demyelination (loss of the insulating myelin sheaths around the nerve fibers). That cross-circuiting triggers a pain sensation when light touch or other normal sensations should be felt instead."
Treatment is highly individualized, Dr. Levy continues, with options including medication, rhizotomy (severing or damaging the nerve, which used to be done directly via open surgery, or can be done percutaneously with glycerol injection, radiofrequency lesioning, or balloon compression), microvascular decompression (surgery to relieve the pressure on the nerve from a crossing artery by moving it off the nerve), and stereotactic radiosurgery.
"Of these, radiosurgery is the safest and least invasive," Dr. Levy states. "The risk is extremely low, and even if it isn't effective, we still have other treatment options open."
But it did prove effective for Thompson. And immediately.
"Results are individualized, too," Dr. Levy cautions. "While we were very pleased with Cheryl's immediate post-treatment relief, we advise patients that it can take days, weeks or even months for the pain to go away. This option is best for someone for whom pain is partially controlled and who can tolerate the potential waiting time."
Thompson marvels at the ease of the process. "I had the planning MRI the week before the procedure. The following Monday, I had the CT scan and they fit the mask (used to pinpoint the radiation beam). The day of the procedure, I was only on the table for 45 minutes for five 'zaps' of radiotherapy. There was no pain." She credits St. Anthony Cancer Center director of radiation oncology Charles Leonard, MD, and "his phenomenal crew for keeping me very well informed and feeling very safe."
"This entire process...and the results...it's kind of mind-blowing."
Find more information about Trigeminal Neuralgia treatment with InterMountain Neurosurgery.