Tufts Medical Center Pioneers a Non-Invasive Treatment for a Condition Causing Horrific Facial Pain

Imagine the feeling of a shock of electricity or a hot poker hitting your face when you talk or chew…or even when the wind blows around you. For those who suffer from trigeminal neuralgia, this is a regular occurrence that causes debilitating pain lasting anywhere from a few seconds to a few minutes. Doctors at Tufts Medical Center have begun to use Gamma Knife radiosurgery to treat patients suffering from the condition.

“We have the only Gamma Knife in Massachusetts — in fact, in all of northern New England,” says Dr. Julian Wu, MD, Chief of Neurosurgical Oncology at Tufts. The Gamma Knife procedure is known for being an alternative treatment for a wide range of brain cancers, benign tumors and vascular malformations — and now for trigeminal neuralgia. Traditional treatment calls for medication, most commonly Tegretol (carbamazepine), an anticonvulsant or anti-seizure medication. Over time, however, patients need stronger doses and develop side effects, or the medication might stop being effective. Gamma Knife is proving to be a viable alternative.

Trigeminal neuralgia generally occurs in people over the age of 50, and the condition is more common in women than in men. The cause is thought to be a “short circuit” that affects the trigeminal nerve, which conducts sensory information from the brain to the face. Gamma Knife radiosurgery “burns” the nerve, changing its insulation to alleviate pain.

“It’s really surgery without a knife,” Dr. Wu says. “Gamma Knife radiosurgery … is a procedure where we focus very high doses of radiation very precisely on the trigeminal nerve, reducing the pain for the patient.” Although the amount of radiation is significant, it poses few risks.

Gamma Knife is an option for anyone with trigeminal neuralgia. “However, older patients … or patients that are at high risk for surgery may particularly benefit, Dr. Wu says, “as this is a one-time outpatient treatment.” The procedure itself is non-invasive but quite complex, requiring a lot of computers, scans and personnel.

The surgery is performed by Dr. Wu, who has more than 20 years’ experience with radio-surgical techniques. U.S. News & World Report considers him to be among the top 1% of neurosurgeons in the nation. The remainder of his team includes a radiation oncologist, radiation physicist, nurse and radiation therapist whose combined expertise ensures that treatment goes according to plan.

In the first part of the procedure, the patient’s head is “framed” to keep the head from moving during the procedure.  Patients are given four separate injections of local anesthetic where the frame is attached to the head. You might feel some discomfort and tightness during the frame placement, but it will subside within minutes. Next, the radiation physicist places a plastic “bubble” on top of the frame to get accurate head measurements and an MRI is done to confirm the target of the Gamma Knife.

Once the team is ready, the patient lies on his or her back on a bed while the frame is connected and slid into the Gamma Knife machine, similar to the process for an MRI.  At this point, the procedure begins. Patients do not feel the radiation or hear noise from the machine during the procedure.  After the surgery, the frame is disconnected from the patient’s head and a dressing is applied where the frame was attached. Most patients are ready to go home within 30 minutes of finishing the Gamma Knife radiosurgery.

Dr. Wu says, “About 80% will report benefit (reduced pain) within the first year of treatment. Typically, the pain is better within six weeks.” He says about 10-20% of the patients experience recurring pain within two to five years after having Gamma Knife radiosurgery.