Trigeminal Neuralgia

This is a disabling condition characterized by severe, repetitive, sharp stabbing pains involving the upper, middle, or lower face on one side. While it may in its early stages respond well to certain medications like Tegretol and Neurontin, often over time higher and higher doses are required, and the medication may even become ineffective. The cause of the disorder is a small blood vessel pushing against the trigeminal nerve (which supplies sensation to the face.) This causes short-circuiting between the nerve fibers and a severe pain syndrome results. One of the main surgical treatments for this disorder is called microvascular decompression. Through a small access (quarter-sized) behind the ear the vessel is microsurgically dissected away from the nerve and a small custom-fitted Teflon pledget is interposed to maintain that separation. In the patient’s case illustrated below, he awakened from surgery with no pain, and he was able to discontinue all his medications.

Metastatic Brain Tumor

Brain tumors may arise from the brain, or spread there from other organ systems (metastases). If there is one solitary metastatic tumor, surgery to remove this is often considered. This is an example of a metastatic tumor from the esophagus in the primary somatomotor cortex shown in Figure A (outlined by box). This produced weakness and numbness of the arm on the opposite side of the body. After complete surgical resection, the postoperative scan shown in Figure B shows no residual tumor. Surgery is more risky when these tumors are in important areas of the brain such as this. This patient went on to make a full recovery.

Figure A

Figure B

Osteoporotic Compression Fracture

With loss of calcium due to osteoporosis, the vertebrae become weak and brittle. Each year there are 700,000 vertebral compression fractures from osteoporosis in the U.S. Wedge compression fractures can produce persistent severe back pain that does not improve with conservative treatments in at least one third of these patients. Treatments have been developed to deliver support to the fractured vertebrae by minimally invasive means. Dr. Stechison was the first surgeon in Atlanta to use Opti-Mesh. This product allows introduction of a polyethylene sac filled with bone graft into the fractured vertebra in an attempt to restore the height of the vertebra and to stabilize the fracture. This involves no incision. This has resulted in complete pain relief in some patients with isolated pathology, and in substantial pain relief in others. As with all surgery there is never a guarantee, and therefore, a realistic expectation is a high probability of relieving a substantial amount of pain in most patients. The benefits when realized should be almost immediate.