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The medical term for facial pain is trigeminal neuralgia.  The NHS describes this condition as: "[a] sudden, severe facial pain. It's often described as a sharp shooting pain or like having an electric shock in the jaw, teeth or gums."

Criteria for the diagnosis of trigeminal neuralgia are:

  • Flurries of 'electrical' shocks in the face
  • Triggering of pain by stimuli such as brushing teeth, eating, or cold to the face
  • Absence of any neurological deficit
  • Alleviation of pain with carbamazepine

In a minority of cases, a structural cause such as a small tumour near the junction of the trigeminal nerve and the brainstem or a plaque of multiply sclerosis is demonstrable. The majority of cases are idiopathic.

For many persons, the pain of trigeminal neuralgia can be controlled by medication, in particular carbamazepine. However, medical treatment may become ineffective or entail intolerable side effects.

Traditional surgical treatments for trigeminal neuralgia refractory to medication include:

  • lesioning of peripheral branches of the nerve
  • injection or radiofrequency lesioning of the (Gasserian) ganglion of the trigeminal nerve
  • open craniotomy with the rationale of separating the trigeminal nerve root from a potentially irritating artery.

Cyberknife™ treatment

In the past decade, radiosurgery through CyberKnife has been refined to produce comparable results to open intracranial surgery with much lower risk.

Through precise radiological imaging and planning by a clinician and physicist, a high dose (60 Gy) of radiation is delivered to a short stretch of trigeminal nerve root between the brainstem and its ganglion.

The initial success rate is high (80 - 90%) but, as with any surgical treatment, recurrence within three to ten years is common: in such cases the treatment can be repeated.

Radiosurgery at high enough dose to relieve pain may cause some facial numbness: in perhaps 1% of cases radiosurgery cause distressing numbness, so called “anaesthesia dolorosa”.

At the London Clinic, Cyberknife treatment of trigeminal neuralgia has been available for a number of  years.

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