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Topic: blood vessel encircling trigeminal nerve (Read 6620 times) |
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firebrix
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blood vessel encircling trigeminal nerve
« on: Nov 9th, 2002, 1:00pm » |
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Greetings all.
Mopar was referred to a pain clinic last week. He went along well armed with info for the unenlightened, but was pleasantly surprised that the doc there was well aware of CH and was informed.
He told Mopar that in some cases a blood vessel wraps itself around the trigeminal nerve compressing it and causing the pain. He also said that an operation could be done to remove the offending blood vessel.
My questions are:
Has anyone else heard of this?
Has anyone else had experience of this?
Would this blood vessel show up on a MRI or cat scan? Like, how would one find out if this were the case?
Prognosis?
Before I get flamed for not using the search I did, but didn't really know how to phrase my search. ??? If there's anyone out there who can enlighten us on this please let us know. Please. Pretty please.  with sugar on top!!
Wishing you all PFDAN and ever seeking enlightenment
firebrixcolor=Purple][/color]
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Jarvis
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Re: blood vessel encircling trigeminal nerve
« Reply #1 on: Nov 9th, 2002, 1:10pm » |
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Hi I dont know much about this idea, but I would think if the nerve were wrapped the pain would be rather constant. No letup. much like a pinched nerve. of course I dont know his situation either.
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firebrix
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Re: blood vessel encircling trigeminal nerve
« Reply #2 on: Nov 9th, 2002, 1:29pm » |
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Mopar has been chronic for three years - episodic before that, but not for long.
He has tried all conventional meds and a few less conventional.
I too thought that the pain would be more constant if this were the case, but his pain occurs just like many other chronics - every two hours at varying intensities. Mostly extremely intense.
He has been diagnosed chronic CH by three neuros.
Thanx for your reply
firebrix
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rick
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Re: blood vessel encircling trigeminal nerve
« Reply #3 on: Nov 9th, 2002, 2:06pm » |
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Firebrix,
I'd be very cautious in considering surgery, based on previous statements made by other members of this board who have taken that route. I've heard some unpleasant stories, and have yet to hear of anyone who has been truly and permanently "cured" as the result of an operation.
I have heard a number of stories regarding some rather nasty side effects related to surgical procedures used to "treat" CH. Hopefully, others here can provide you with more details.
Peace,
-R
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Mark C
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Re: blood vessel encircling trigeminal nerve
« Reply #4 on: Nov 9th, 2002, 9:38pm » |
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I agree with caution..............but I would piss on a spark plug if I thought it would help my head. 
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Marc
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Re: blood vessel encircling trigeminal nerve
« Reply #5 on: Nov 9th, 2002, 10:42pm » |
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An MRA is often used to determine if there is any interference between the two. When they are pushing against each other, a form of Trigeminal Neuralgia can result. This is a very different condition than CH's.
If so, a small plastic wafer or shunt can be surgically inserted between them in order to eliminate (or at least reduce) the irritation to the nerve bundle.
From what I've read, this type of surgery is often very effective to relieve that particular condition.
Good luck,
Marc
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| « Last Edit: Nov 10th, 2002, 2:09am by Marc » |
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Opus
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Re: blood vessel encircling trigeminal nerve
« Reply #6 on: Nov 10th, 2002, 7:13pm » |
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I have heard of this but can't remember the name of the illness. Victims get horrible constant pain in their face and elsewhere and surgery can be done. They put shredded teflon between the nerve and blood vessel. If the same happens in CH it is probably in the brain and is not easy to get to. PJB
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| « Last Edit: Nov 10th, 2002, 7:15pm by Opus » |
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goldenpuppylady
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Re: blood vessel encircling trigeminal nerve
« Reply #7 on: Nov 10th, 2002, 8:03pm » |
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I know of a man in Iowa who had that nerve cut at Mayo's clinic, and was told he would be no more pain, and he suffered some mini strokes, and the headaches have returned. Don't know if this is typical, but just what happened to him . He did suffer paralysis on that side of his face, which they told him he would.
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Ueli
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Re: blood vessel encircling trigeminal nerve
« Reply #8 on: Nov 10th, 2002, 9:07pm » |
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Hi Firebrix and Mopar,
The interaction between the trigeminal nerve and a blood vessel is with the main artery, as you can see on this Picture of the trigeminal nerve. I have never heard of a minor blood vessel (one that could be cut) wrapped around the trigeminus.
Some charlatans, like Dannyboy and Ali, recommend some surgery to decompress a minor branch of the trigeminal in the temple area. Maybe that helps some selected cases of meegraines, but certainly not for CH, despite the fact that these quacks try to mix up CH and M., in an attempt to find more suckers.
For any surgical procedure you should- insit that this procedure is recommended by experts independent from the performing surgeon,
- ask for reviews that clearly give the success rate and the rate of adverse side effects.
Using these criteria it is a fact: Surgical procedures can help for refractory cases of Trigeminal Neuralgia. Independent experts do not recommend it for CH (or meegraines).
I would say: Don't go for that!
PFNADs
Ueli
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Marc
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Re: blood vessel encircling trigeminal nerve
« Reply #9 on: Nov 10th, 2002, 10:29pm » |
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Thanks Ueli,
I guess I didn't say it clearly enough.
Marc
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firebrix
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Re: blood vessel encircling trigeminal nerve
« Reply #10 on: Nov 11th, 2002, 4:06pm » |
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Thanx for all your replies. We certainly won't rush in to this procedure. Really appreciate your help guys!
PFDAN to you all
firebrix and Mopar
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Tom
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Re: blood vessel encircling trigeminal nerve
« Reply #11 on: Nov 11th, 2002, 6:01pm » |
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Too often it's not easy to stand the hybris of laymen/women giving «advices» on this board, without knowing a n y t h i n g about the subject they are speaking about.
1st)
There is not only o n e kind of trigeminal nerve surgery, meanwhile there are different very advanced surgical methods of this surgery that (not always, but in most cases) preserve the full sensibility of the a.m. nerve. Antiquated methods are debilitating, invalidizing and usually irreversible in their numbness producing effect, i.e. methods that involve the dissection of branches of the nerve. BUT the "TRIGEMINAL NEURALGIA MICROVASCULAR DECOMPRESSION" IS NOT A DISSECTION OF THE NERVE !!!
2nd)
Trigeminal nerve surgery is usually useless in CH, but there is also the so called " Cluster Tic Syndrome", a mixed «something» between CH and Trigeminal Neuralgia. In these cases the (central) Microvascular Decompression of the Trigeminal Nerve can be of a great benefit for the sufferer, without the well known disadvantages of the conventional dissective trigeminal surgery.
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http://imigraine.net/other/clustertic.html
Cluster-tic headache
There is now recognized an overlap between trigeminal neuralgia-type headache and cluster headaches. The diagnostic characteristics of the cluster-tic syndrome are analyzed by Alberca and Ochoa (1994). The headaches are characterized by short attacks of pain localized in the facial territory with autonomic signs during attacks which come in clusters. Still another overlap syndrome such as chronic paroxysmal hemicrania and tic has been reported (Mulleners and Verhagen, 1996).
--------------- www.mhni.com/faqs_cluster.html#tic
What is cluster tic syndrome?
The cluster tic syndrome features the primary symptoms of cluster headache but with the added component of stabbing, ice-pick neuralgic-like components involving the eye, face, and jaw. The syndrome is found in 10-20% of patients but is often undiagnosed. True trigeminal neuralgia may coexist with cluster headache.
Alberca and Ochoa (1994) reviewed 37 reported cases of cluster tic syndrome. They noted equal gender representation and found that trigeminal neuralgia usually appeared first. Some attacks appeared to blend both neuralgia and cluster headache symptomatology and could be triggered by touching of the upper lip on the involved side. Medical treatment was often not effective, although a combination of cluster headache therapy with that for trigeminal neuralgia was sometimes useful.
Several antineuralgic agents are available. These include carbamazepine, phenytoin, baclofen valproate, and clonazepam. Most recently, gabapentin has shown promising results in neuropathic pain disorders. As for surgical interventions, suboccipital surgery (Solomon, 1985) revealed compression of the trigeminal nerve by aberrant vasculature, and following treatment, the neuralgic component resolved.
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http://neurosurgery.mgh.harvard.edu/mvd.htm
Trigeminal neuralgia or tic doloureux...This irritation is occassionally due to benign tumors or to multiple sclerosis either of which can usually be detected by a high quality MRI of the brain. In the majority of cases, however, imaging of the brain does not reveal a cause of the nerve irritation. In such cases a small vessel (usually an artery but occassionally a vein) is often found to be compressing the root entry zone of the trigeminal nerve at the brainstem.
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For more information about the mentioned surgery put into the Google: "trigeminal neuralgia microvascular decompression" and read ! - following some examples:
--------------- www.neurosurgery.ufl.edu/ClinSpec/trigeminal.html www.neurosurgery.ufl.edu/FacultyPage/TicBrochure.html
Microvascular decompression (the Janetta procedure) does not result in the numbness associated with a radiofrequency procedure. The vascular decompression operation is a major surgical procedure, which commonly requires 2 to 3 days in the hospital after surgery. After the induction of general anesthesia, the patient is positioned, prepped, and draped for a retromastoid craniotomy. A small (half dollar sized) opening in the skull, allows the superior lateral corner of the cerebellum to be retracted. The trigeminal nerve is easily visualized with the operating microscope. During the operation, a vessel (often the superior cerebellar artery) is usually found compressing the root entry zone of the trigeminal nerve. This vessel is dissected free and padded to prevent recurrent compression. This results in permanent relief of pain, without facial numbness, in the vast majority of cases.
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http://drjho.com/id68.htm
Endoscopic Microvascular Decompression
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Thomas
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| « Last Edit: Nov 11th, 2002, 6:06pm by Tom » |
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Opus
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Re: blood vessel encircling trigeminal nerve
« Reply #12 on: Nov 11th, 2002, 6:25pm » |
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Thanks Tom, I was waiting for someone who knew the facts and where to find them. PJB
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| « Last Edit: Nov 11th, 2002, 9:32pm by Opus » |
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meggregg
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Re: blood vessel encircling trigeminal nerve
« Reply #13 on: Nov 11th, 2002, 9:19pm » |
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I just posted something about surgery to alleviate the pain of cluster headaches. You may want to take a quick peek at it. I am checking it out in depth... I am being scheduled for additional specific emg testing on the facial nerves (mine also involves facial paralysis w/ch). As I know more, I can update. But to me, if surgery is what it takes to have a life again, as long as there is hope, I'll try about anything to relieve the pain.
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dmaislin
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Re: blood vessel encircling trigeminal nerve
« Reply #14 on: Nov 17th, 2002, 8:08am » |
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The headaches are more closely related to a epilectic seizure of the brain. There are some bad cells, an overactive hypothalamus (your body clock) with a minute difference in the size in the grey matter from the left and right side. Over time, something (yet to be discovered) finally triggers the hypothalamus to send a signal which starts the headache cycle. Headaches put you in a cycle until your body clock can be reset to not trigger the headaches any longer. Preventative medicine is key so that you can mess with the clock to stop the clusters. The latest cluster headache study is being conducted with civamide:
http://archneur.ama-assn.org/issues/v59n6/abs/noc10084.html
The thing is, solve the issue at the source, not at the vessel. Something is instructing the blood vessels to misbehave and that is what must be fixed.
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ScorpionHand
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Re: blood vessel encircling trigeminal nerve
« Reply #15 on: Nov 17th, 2002, 12:59pm » |
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dmaislin
Quote:| solve the issue at the source, not at the vessel |
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I'm with you there. Your body does not send blood to a specific area for no reason.
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Tom
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Re: blood vessel encircling trigeminal nerve
« Reply #16 on: Nov 17th, 2002, 5:31pm » |
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Refering to the "Trigeminal Decompression Surgery" I explicitly emphasized :
2nd)
Trigeminal nerve surgery is usually useless in CH...
Thomas
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Charlie
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Re: blood vessel encircling trigeminal nerve
« Reply #17 on: Nov 18th, 2002, 5:06am » |
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All I know is that there are very few, if any, who have posted here that say what a wonderful thing their surgery was. Find out everything and more. So far, it seems iffy at best. I wish it weren't the case, but sadly, it is.
Charlie
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firebrix
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Re: blood vessel encircling trigeminal nerve
« Reply #18 on: Nov 18th, 2002, 5:21pm » |
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You guys are too much! ;D
Thank you for all your well researched and deeply thought-about replies.
Having read all the info, we too realise that there is little chance of this working, but when ideas are presented by professionals with such confidence, one is tempted to think they might just be on to it, this time. 
I am now reminded that the best info is from those who contribute to this site and the Ouch site!
Thank you all very much and hoping you are all having happy days and no pain.
Always ready to help if I can be helpful
firebrix
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dannyboy
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Re: blood vessel encircling trigeminal nerve
« Reply #19 on: Nov 19th, 2002, 7:08pm » |
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Hello Ueli,
Missing me were you?
Hey has anyone seen sweet_landings? And what a sweet_landing it was. She got asked to "move on' because she didn't have clusters. OUCH!
She hated me more than Ted though which takes some doing. Although I have to admit to taking the 'prick trophy' two years running now. Heavily contested award that it is in this room, I plan to hold on to it.
Tom, you're the Bomb. Rock on!
But I don't think it's fair to call Ueli a woman. Woman have done nothing to deserve it.
Stay away from the Lions kids.
Danny
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| « Last Edit: Nov 19th, 2002, 7:26pm by dannyboy » |
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Ueli
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Re: blood vessel encircling trigeminal nerve
« Reply #20 on: Nov 19th, 2002, 7:34pm » |
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It seems he swallowed the elephant feet.
And I had hoped DJ banned him for good. 
(And why, dickhead, don't you ask sweet_landings directly for her opinion about me?)
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dannyboy
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Re: blood vessel encircling trigeminal nerve
« Reply #21 on: Nov 19th, 2002, 10:08pm » |
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You ban me in a Dream you better wake up and apologise
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David G
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Re: blood vessel encircling trigeminal nerve
« Reply #22 on: Nov 20th, 2002, 9:20pm » |
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I have been CH free for over one year after surgery.
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Riccardo
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Re: blood vessel encircling trigeminal nerve
« Reply #23 on: Nov 21st, 2002, 2:16am » |
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David, I'm happy for you. But...... isn't surgery a bit ...generic?!?
The ONLY surgery with good (and tested.... also by Doc Goadsby) results is the deep electrical stimulation of the hypothalamus, did at Besta in Milan (Italy).
But.... there is always a but... Is a risky surgery (you run the same risks of a brain aneurysm removed). So it can be done ONLY in chronics that have no success with meds.
Another risk you could run (2 patients on  is that the CH ....swap side!! (and this means another surgery.... etc etc)
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hdbngr
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Re: blood vessel encircling trigeminal nerve
« Reply #24 on: Nov 27th, 2002, 9:58am » |
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Yes, have heard of it. I have also been diagnosed with clusters and went to U of M in 1999 to have this surgery. They call it a micirovascular decompression or a plain old craneotomy (which means they open your skull).
Why did they do it? I'm chronic. What did they find? Two nerves, number five and seven, were wrapped around each other and engoged withother blood vessels. One of these nerves is the trigeminal nerve. They use microscopes to see the nerves, and said there was a severe indentation of the trigeminal nerve, which they attempt to move apart and keep apart by inserting small, teflon pledgets.
None of this ever showed up on an MRI or CAT scan. They sort of guess that the problem is there and if they find what they expect, they try to fix it.
Did it help? Yes, for awhile. I had significantly reduced attacks and pain for almost a year. However, the recovery time is long, about three months. The patient needs to stay on steroids (decadron) to control brain swelling, which is painful. They genally drill a hole behind the ear and then either fill in the skull with a mixture of your own ground bone and blood or a teflon plate.
They offered no guarantees, so no one was disappointed, except me. They said they were sure it would help for awhile, but might not be permanent. There is a risk of surgical meningitis and latex allergies developing. The surgery itself took about 4-5 hours.
Would I do it again? No. But it had cured the pain permanantly, I would be singing a different song of course. Weighing recovery time, it wouldn't be worth it for me to do it again unless I had a guarantee, and they don't offer those. There are other treatments out there that are a lot less invasive. If they say this is what they want to do, I would ask some MAJOR ??? ??? questions first.
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