Saving Faces: Nerve Disorders

Pain and suffering can be quelled with the well-deployed electrode of John Tew at the UC Medical Center and Mayfield Clinic.

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Trigeminal neuralgia is a seizure-like disorder affecting the cranial nerve that supplies the feeling to the face. It’s been recognized for over 2,000 years. It’s known as the “suicide disease”—people kill themselves because they can’t get relief. It’s worse than misery; the French call it tic douloureux—“painful tic.” Your face frequently turns red [and it’s] characterized by spasms.

Some of the first treatments were facial nerve injections. They knew if you paralyzed the face you could create a Bell’s palsy that would stop the movement; it was recognized that production of Bell’s palsy would, through limiting movement, allay the pain. It was at least a temporary, although somewhat barbaric, treatment.

Since about 1950 we’ve known that pressure on the nerve from blood vessels, tumors, or any other compressive lesions can cause what amounts to mild irritation of the nerve and can produce this painful syndrome. It worsens as the nerve continues to deteriorate, but when the patient is not having the pain you don’t find anything wrong. So the goal is to correct the underlying problem.

In the early surgical procedures you had to go inside the skin or the skull to get to the nerve. The original treatments in the 1930s were done by touching a hot cautery or heat probe [to the nerve], but that heat could not be monitored or controlled.

What my team and I developed is an electrode to carry radio frequency—kind of like a microwave current—that allows you to heat the nerve and record the temperature of the probe while you’re heating it. This probe has a curve to it and we can seek out the fibers of the nerve to localize the feeling fibers.

We wake the patient up while we’re doing the procedure so we can monitor the results; you put electrodes in various areas and you stimulate to reproduce the pain. A needle goes into a very specific part of the nerve from the outside and the heat will be delivered for a limited distance around the electrode. You want to spare the nerve that allows you to clench your jaw, plus you want to spare the feeling for touch.

The procedure takes 20 minutes and [then] they stay around for another hour or two and go home. Ninety-nine percent of patients have immediate pain relief.

The ideal is not to [have] numbness, because the procedure can be repeated; with mild numbness the recurrence is 60 percent, with major numbness the recurrence is 25 percent. Most people will say “anything [even some numbness] is better than what I have.”

I’ve been a neurosurgeon for 50 years. I’ve treated more than 20,000 people by surgery, more than 5,000 for trigeminal neuralgia. It’s not the most difficult surgery, but it’s by far the most satisfying and has given me a sense of empathy, compassion, and being worthwhile.

Originally published in the January 2013 issue.

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