Fall 2013

Delivering Relief From Trigeminal Neuralgia
Long-Suffering Patients Find An End To Intense Facial Pain

Trigeminal neuralgia (TN) has been called one of the most painful conditions a person can endure. With TN, the face becomes extremely sensitive to touch, and strong electric shock sensations are triggered when patients speak, eat, touch their faces, or brush their teeth. TN often causes people to become more introverted. Men stop shaving. Women stop using makeup. Their entire lives are affected. Anthony Asher, MD, FACS, of Carolina Neurosurgery & Spine Associates is the only provider in the region offering comprehensive care for patients with TN.

“We have radically changed people’s lives,” said Dr. Asher. “When TN patients return for follow-up visits they’re literally different people. Their demeanors have changed, and their true personalities are evident. I often feel like I’m meeting them for the first time.”

The trigeminal nerve emerges from the brain stem and branches across the face to sense touch and control chewing. When this nerve misfires, it causes intense facial pain.
During microvascular decompression, a Teflon sponge is placed between the trigeminal nerve and the artery that is causing the compression to serve as a shock absorber.
For most patients, TN occurs when the trigeminal nerve, which runs from the base of the brain and branches through the side of the face, misfires and causes short bursts of extreme pain. The condition is usually the result of the trigeminal nerve being compressed by an artery. TN can also be caused by a tumor or Multiple Slcerosis. In 20% of patients, the cause can’t be determined.

The primary function of the trigeminal nerve is to sense touch and control the chewing muscles. When this nerve malfunctions, the pain is intense and can be both physically and emotionally incapacitating. Attacks can last from a few seconds to a few minutes and are usually felt on one side of the face. Patients with TN often experience pain-free intervals that last for weeks or even months. TN can be difficult to diagnose by healthcare providers who are unfamiliar with the disorder. The pain these patients experience is often mistaken for cluster headaches, dental disorders, or other conditions.

Carolina Neurosurgery & Spine Associates has been at the forefront of treating TN for decades. Dr. Jerry Greenhoot, one of the original members of our practice, was an early pioneer in TN therapies. Since Dr. Greenhoots’ retirement 20 years ago, Dr. Asher has continued to make the care of these patients a priority. We offer four treatment options that Dr. Asher and other national leaders in the field have found to be most effective.


Medical Therapy can be effective in the initial treatment of TN. Unfortunately, many TN patients ultimately become resistant to medical therapy or suffer from severe side-effects such as sedation. In those instances, surgical therapies can often provide lasting relief.

Percutaneous Rhizolysis is a minimally invasive treatment option for TN. It involves injecting a drug (glycerol) using X-ray guidance into the area adjacent to the trigeminal ganglion. The majority of patients have pain relief within one week after this procedure. Percutaneous rhizolysis is different from injections into the peripheral branches of the trigeminal nerve, which generally wear off quickly and are considered to be ineffective by providers experienced in the treatment of TN.

Patient Liza Hart chose percutaneous rhizolysis after enduring incredible pain for eight years due to TN.

“It felt like fireworks were going off in my mouth. I was miserable,” Liza explained. “I tried different medications over the years, but the pain kept getting worse.”

After being referred to Dr. Asher, Liza underwent percutaneous rhizolysis in January of 2013 and has been pain free ever since.

“That quick procedure was life-changing for me,” said Liza.

Stereotactic Radiosurgery uses focused radiation to provide pain relief by destroying small portions of the trigeminal nerve. This procedure is performed with the assistance of a radiation oncologist. While stereotactic radiosurgery doesn’t always provide complete pain relief, it is well tolerated by elderly or debilitated patients and is the preferred treatment for this patient population.

Microvascular Decompression (MVD) is the gold standard for treatment of TN. This surgery involves removal of a small window of bone near the area where the trigeminal nerve emerges from the brainstem. The artery that is compressing the nerve is then located, and a Teflon sponge is inserted to serve as a shock absorber. Patients are usually hospitalized for two to three days following this surgery. The success rate for pain relief after MVD is about 80-90%.

Patient Bob Price found complete relief after having the MVD procedure. For over 25 years he had lived with sedating side effects that resulted from the strong medication he was taking to manage his TN pain. After coming to see Dr. Asher, Bob decided that surgery was his best option.

“It’s like a brand-new life for me,” said Bob. “I’m enjoying every single day.”

Dr. Asher believes there are many patients living with unrelenting pain who simply don’t realize that effective treatments for TN exist.

“We have great therapies that provide real relief. I wish all trigeminal neuralgia sufferers were aware of that,” said Dr. Asher. “It’s extremely satisfying to make such a fundamental difference in patients’ lives.”

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