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You know, in cartoons, when the protagonist is in contact with an electric discharge? The passage leads to the skeleton that is visualized, signifying the intensity of what is happening. Well, given the due proportions and without leaving room for imagination, something similar can occur when a person has to deal with the neuralgia of the trigeminal nerve.
The picture, fortunately not very frequent since affects 3-5 in 100,000 people per year, it is in fact characterized by a severe pain described as an electrical discharge localized in the area of the cheeks, teeth, gums, jaw and lips, more rarely eyes or forehead. A little stimulation is enough to trigger it, such as chewing, touching your face, drinking, talking or brushing your teeth. Unfortunately this picture can become chronic, and then it is necessary to focus on specific treatments, especially if drug therapy is no longer sufficient. How to behave? We reconstruct, together with the experts of Humanitas in Milan, the alternative ways to medications to deal with the situation.
Medicines, but not only
“The trigeminal nerve is the nerve that carries the information perceived in the face to the brain – explains Maurizio Fornari, head of Humanitas Head of Cranial and Spinal Neurosurgery -. There cause of the disease it is only partially known and is attributed to an alteration of the sheaths of the nerve fibers of the portion of the nerve that is inside the skull, which can be highlighted with magnetic resonance. “
However, it must be said that this alteration caused by the contact between the nerve and an intracranial artery it is not always demonstrable. “Therefore, in a considerable percentage of cases, neuralgia is defined idiopathic as there is no demonstrable cause – resumes the expert -. In any case, however, it is possible to turn off the pain ”.
The first treatment of neuralgia it is pharmacological but in about seven out of ten people, unfortunately, if the picture proceeds over time, there is a risk of becoming resistant to treatments. And here is where specific treatments can come into play, obviously if the specialist recommends, such as microsurgery (vascular microdecompression), radiosurgery or radiofrequency (thermorizotomy).
Vascular microdecompression is a microsurgical procedure that identifies the contact area between the blood vessel and the trigeminal nerve. “The vessel involved in the neurovascular conflict is separated from the nerve with a microscopic technique, then interposing between the two synthetic or autologous material (cellulose, or fragments of muscle tissue) – explains Federico Pessina, head of Cranial Neurosurgery at Humanitas and professor at Humanitas University. Surgery leads to the disappearance of pain in most patients, but the selection of candidates for this type of intervention is extremely rigorous. “
Radiation and radio frequency
You can also use, in specific cases, a kind of Radiological “scalpel”. Is called Gamma Knife. “The Gamma Knife allows you to focus 192 beams of gamma rays (ionizing radiation) on the intracranial part of the trigeminal nerve, altering its fibers – says Piero Picozzi, neurosurgeon at Humanitas, responsible for Gamma Knife -. In this way the transmission of pain is interrupted. MRI images acquired before treatment are used as a guide. Usually, the effect of radiosurgery is not immediate, but takes a few weeks ”. Finally, the thermorizotomy percutaneous by radiofrequency is based on the positioning of an needle cannula inserted through the skin of the cheek until it reaches a particular area, the Gasser ganglion, where the pain information coming from the face is conveyed.
As Angelo Franzini, Humanitas neurosurgeon explains, “once the needle cannula is positioned, a rigid electrode is inserted from the end of which is generated heat produced by radio frequency. Heat selectively alters the painful fibers within the Gasser ganglion and to a lesser extent the fibers that carry tactile sensitivity, which is only reduced, allowing normal restoration of all trigeminal nerve functions. For the correct localization of the nerve fibers involved in the genesis of pain, the collaboration of the patient is required, who is awakened by anesthesia for a short period during the procedure. This allows to concentrate the treatment only on the nerve fibers involved in the genesis of neuralgia. “
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