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Delicate skull base surgery can give patients with debilitating facial pain a new lease on life

Trigeminal neuralgia is universally considered to be the most painful affliction known to adult men and women. Historically, treatment modalities have been only moderately effective, but a new type of highly specialized skull base brain surgery called Microvascular Decompression can eliminate pain immediately and give patients back their lives.

Universally acknowledged as the most painful affliction known to adult men and women, Trigeminal Neuralgia (or severe facial pain) affects thousands of Americans every year - and many of them do not yet know that help is available. Until 1990, relatively little was known about this debilitating disorder, and until recently, treatment options were limited and largely ineffective. Now, however, thanks to a highly specialized type of skull base surgery known as Microvascular Decompression, sufferers can get immediate relief.

According to Hrayr K. Shahinian, M.D., Director of Cedars-Sinai Medical Center's Skull Base Institute, Trigeminal Neuralgia is a disabling disorder of the fifth cranial (trigeminal) nerve. Pressure on this nerve can cause episodes of intense, stabbing, electric shock-like pain in the face. "The pain we are talking about is excruciating - extremely intense, extremely severe," says Dr. Shahinian. "The shock of it can actually cause a sufferer's head to snap back, or it can immobilize the individual. The pain attacks viciously and without warning and left untreated, tends to worsen over time."

This severe facial pain is caused when a blood vessel is in contact with the trigeminal nerve inside the head and is applying pressure to the nerve. Relieving that pressure is a delicate, time-consuming surgical procedure that can take up to four hours. During the procedure, surgeons meticulously separate the nerve and blood vessel, then insert a Teflon disk between them. Once that pressure has been relieved, patients often report immediate and complete relief from the pain that had become a part of their lives.

"The pain was so severe that sometimes it would cause my head to snap back," says Kurt Kasinoff, a 33-year-old production manager who underwent Microvascular Decompression in Aug., 1997. "It would start as a sharp pain on my left upper lip and would shoot up through my eye, forehead and sometimes the roof of my mouth. There would be no warning, and something as slight as the air from a breeze could start it off. The pain was literally immobilizing - all I could do was sit perfectly still and not move. It was like having a tooth filled without any Novocain," Kasinoff remembers.

Jean Greenebaum, 72, agrees. She underwent a Microvascular Decompression procedure after suffering with the pain for 10 years. "The pain was sudden, severe and unrelenting," she says. "When it happened, people could tell just by looking at me that something had happened, because I would just freeze -- fearful of making even the slightest movement. I remember once having dinner in a restaurant with my daughter, and the pain came. I didn't make a sound, but tears rolled down my cheeks."

Both Kasinoff and Greenebaum initially thought that the pain was caused by a toothache and went to several dentists. Both also tried various medications without success, and Greenebaum even underwent two root canals and other treatment options before she was finally referred to a neurologist. Initially, he was reluctant to refer her for surgery because of her age. However, after being examined by specialists at the Skull Base Institute, she was deemed a good candidate for the procedure and decided to move forward with it.

After their respective surgeries, both Kasinoff and Greenebaum enjoyed prompt relief from the pain. "It completely eliminated the pain," says Kasinoff.

"I wish I'd known about this surgical procedure years ago," Greenebaum adds. "It was certainly worthwhile, and if I had it to do over again, I wouldn't hesitate to go this route. What is more, I would encourage other people -- even older people -- to consider this treatment, too. When I woke up from the surgery, the pain was gone immediately."