The complexity of managing facial disorders requires a dedicated, multidisciplinary approach. Patients can find this special expertise at the Facial Pain, Spasm and Paralysis Center (Facial PSP Center) at The Skull Base Institute. This joint venture brings together Dr. Shahinian and several renowned pain specialists, including Dr. Robert Merrill, Director of UCLA’s Orofacial Pain Center, and Dr. Ronald Young, Medical Director of California Neuroscience Institute. The Facial PSP Center offers a comprehensive approach to the diagnosis and treatment of facial pain, spasm and paralysis. Treatment alternatives include medical, surgical, radiosurgical, psychological and pharmacological management - each customized to the patient’s needs. Pain experts, surgeons, neurologists, psychologists and a full-time social worker closely collaborate to provide the most appropriate care.

SKULLBASE INSTITUTE are THE leading providers in surgeries for Trigeminal Neuralgia. They’ve performed thousands of surgeries as last resort when other doctors have all claimed the brain surgery was in-operable. They have performed thousands of surgeries as last resort when other doctors have all claimed the brain surgery was in-operable.

http://skullbaseinstitute.com/trigeminal-neuralgia-tn/- Trigeminal Neuralgia

http://skullbaseinstitute.com/trigeminal-neuralgia-tn/ - Keyhole surgery

http://skullbaseinstitute.com/ -The Skullbase Institute

Trigeminal Neuralgia: Endoscopic "keyhole approach" for microvascular nerve compression syndromes

The endoscope is being used at the Skull Base Institute to treat trigeminal neuralgia. This condition is universally acknowledged as the most painful affliction known to adult men and women and affects thousands of Americans each year. The episodes of intense, stabbing, electric shock-like facial pain are caused when a blood vessel comes in contact with the fifth cranial (trigeminal) nerve, applying pressure to the nerve. Patients with neurovascular problems such as trigeminal neuralgia, hemifacial spasm, intractable vertigo and spasmodic torticollis benefit from the Skull Base Institute’s innovative endoscopic "keyhole" approach to these disorders.

At the Institute, surgeons perform this delicate microvascular decompression procedure through a dime-size opening behind the ear. Through this opening, surgeons insert a 2.7 mm endoscope. They can then identify the problem and perform the procedure - meticulously separating the nerve and blood vessel, and inserting a Teflon disk between them. Once the pressure has been relieved, patients often report immediate and complete relief from the pain.

In many cases, the endoscopic "keyhole" surgery is the preferred approach to traditional methods, in which instruments are inserted in a larger opening behind the ear, and the brain pushed aside to reach the nerve compression area.

Since the introduction of the endoscopic keyhole approach, numerous presentations have been made nationally and internationally to both colleagues in the field and patients suffering from neurovascular compression syndromes such as Trigeminal Neuralgia. Video tapes of the procedure have also been requested by both the National Trigeminal Neuralgia Association and several of the regional support groups and have been made available.

3-D Endoscopy of the Posterior Fossa
Of all the exciting advances within the field of microvascular nerve compression syndromes, the near future advent of 3-D endoscopy will be the next refinement in the surgical management of these disorders. We are currently experimenting with new technology that once again will revolutionize the way the keyhole endoscopic decompression procedure is performed. Of all the current procedures that are being performed at the base of the skull we are confident that the surgical treatment for Trigeminal Neuralgia and Hemifacial Spasms will be one of the first to benefit from the application of 3-D endoscopy.

Overview
Trigeminal neuralgia (TN) is a pain syndrome characterized by intermittent, shooting pain in the face along the distribution of the fifth (trigeminal) cranial nerve. The trigeminal nerve is the largest of twelve cranial nerves and has three divisions (ophthalmic, maxillary, and mandibular), also known as (V1, V2 and V3) respectively. These three branches are the major carrier of sensory information from the face to the brain.

Neuralgia, simply means pain; the pain is characteristically intense, sharp, episodic, periodical, excruciating, stabbing and short lasting and often accompanied by a brief facial spasm or tic, hence the French term "tic doulourex". The distribution of pain is typically unilateral i.e. restricted to one side of the face, and follows the sensory distribution of cranial nerve V, typically along the (V2) and/or the (V3) divisions. Rarely TN may manifest as "status trigeminus", a rapid successtion of tic-like spasms triggered by seemingly minor stimuli.

The condition is the most frequently occurring of all the nerve pain disorders, TN can occur at any age but usually has its onset in women over fifty, male-to-female ratio is 2:3, and its annual incidence is 4/100,000.

TN is distinct but may often be confused and should be differentiated from other closely similar conditions such as atypical facial pain, glossopharyngeal neuralgia, temporomandibular joint pain, sinusitis, migraine headache, other forms of neuritis, and dental problems. These clinical conditions have to be ruled out to establish the diagnosis of TN.

Causes
The condition occurs due to an abnormality that exists both at the level of the inner nerve fibers which carry nerve sensation and at the lining covering the trigeminal nerve (myelin sheath). The nerve fibers behave like an electrical cable leading to electric, shock-like pain induced by a stimulus consisting of a touch or jerk. TN is observed to run in families suggesting a genetic liability for the disease.

The most common triggering cause of TN is an enlarged looping artery or vein pressing on the trigeminal nerve at the base of the brain close to the pons (a part of the brainstem).

Other causes such as aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots at the pons and cause symptoms of TN to occur, these can be identified and ruled out by MRI scan of the brain.

Symptoms
There are 3 branches of the trigeminal nerve: the ophthalmic (V1), maxillary (V2), and mandibular (V3). Most commonly TN occurs along the distribution of the maxillary branch (V2), manifesting itself as a sharp pain which runs along the cheekbone, most of the nose, upper lip, and upper teeth. The next most commonly affected division of the trigeminal is the mandibular branch (V3), affecting the lower cheek, lower lip, and jaw.