Trigeminal Neuralgia (TN) (Facial Pain) is characterized by sudden bursts (paroxysms) of face pain. These bursts are often triggered by a light touch around the mouth or face or by talking, eating or brushing one's teeth. The pain experienced in the areas supplied by the trigeminal nerve are the cheeks, jaw, teeth, gums, lips and less often around the eye or forehead. Many patients first seek help from dental professionals because the pain often occurs in the area of the mouth.

Incidence and Prevalence+
Approximately 14,000 people develop TN(facial pain) each year in the United States and about 140,000 people have the condition. Trigeminal Neuralgia (facial pain) is more common in patients with multiple sclerosis.

Treatment Medication
Is often effective for pain management, but can cause serious side effects. In the past, patients with TN (facial pain) did not consider neurosurgical options, which carried higher risks, until the pain or medication became unbearable.

Gamma Knife® Radiosurgery (GKRS)
Is the most recent and least invasive neurosurgical treatment for TN (facial pain). Of all the surgical procedures, it's the least likely to cause complications and uncomfortable new facial sensations (dysesthesias). Gamma Knife® radiosurgery is a method for treating certain problems in the brain without making an incision. More than 200 beams of cobalt-60 radiation are focused precisely on a specific region in the brain. For TN (facial pain), the target area is the trigeminal nerve, where it leaves the brain. The treatment does not require general anesthesia and the hospital stay is usually less than five hours.

Who is a Good Candidate?

Any patient with TN(facial pain) who has pain or has difficulty with their pain relief medications is an ideal candidate. The patient's age or medical condition does not affect the decision to have GKRS; the elderly and medically infirm can undergo this treatment. Patients who are receiving anticoagulants for other medical conditions do not have to stop or reverse the anticoagulation therapy prior to GKRS. Those who have had previous procedures for TN (facial pain) also may undergo GKRS. Patients who are concerned about the possibility of numbness are particularly good candidates for GKRS, because the chance of postoperative numbness occurring is very small. Patients who poorly tolerate medicines given for sedation and pain relief during a procedure are also very suitable because these medications are not necessary.

Outcomes*
Approximately 85 to 90 percent of patients who have undergone GKRS experience excellent or good pain relief. Onset of pain relief may occur one day to four months after the procedure. About half of patients will experience pain relief within four weeks. Recurrent pain occurs within three years in 10 percent of patients. The Gamma Knife® has been used in the U.S. since 1987, and most cases of TN(facial pain) have been treated during the past five years. Although there is not much information on long-term effects, initial and medium range follow-up suggest that GKRS is not only effective, but also very safe.

Complications
Major complications have not been reported. Additional numbness in the face or new facial sensations occur in less than 10 percent of patients.
+Gamma Knife and TN. IRSA can be found at: http://www.irsa
*Statistical information available at irsa.org/trigeminal_neuralgia.html.