Surgeon Had No Choice but to Operate on Elderly Man

Daily Herald

Imagine if the simple act of talking, eating, drinking – even touching – resulted in severe, stabbing facial pain.

That's what happens in people with trigeminal neuralgia, a disorder of the trigeminal nerve that sprouts from the brain stem and supplies sensation to much of the head.

The pain is brief but intense. It often makes people wince, which is why the disorder is commonly called tic douloureux, meaning “painful twitch.”

A 29-year-old man who'd lived with this excruciating condition for three years was referred to Dr. Jonathan Citow, chairman of neurosurgery at Condell Medical Center in Lib.

The elderly patient hadn't responded to the anti-seizure medications that often bring trigeminal neuralgia under control.

Citow decided to try a procedure that had worked on other patients with this disorder.

It's called balloon compression. Citow inserted a needle about a centimeter from the man's mouth, tunneled it under the patient's cheek and into the space beneath the skull where the nerve branches out.

“Through the needle you put a catheter with a balloon on the end and inflate the balloon onto the nerve to smush it and prevent the pain,” citow said. “In most cases, it works.”

In this case, it didn't.

Citow couldn't figure out why this man's neuralgia wasn't responding to any treatment.

He knew of one other option left to try, but he didn't relish the idea of putting a 92-year-old man under anesthesia for a major operation. There were a lot of risks involved. His blood pressure might plummet. His blood vessels might get blocked, resulting in a deadly stroke.

“Surgery on the elderly is much more dangerous and high risk than surgery on a younger person,” Citow said.

Still, the man was willing to risk it all rather than live with his pain.

“His wife said that if we couldn't fix it, we should just kill him under anesthesia,” Citow said. “It was that debilitating”.

“Lying on top of it was a large blood vessel that was beating onto the nerve,” Citow said. “Every time it pulsated it would irritate the nerve more”.

The surgeon cut all of the scar tissue and connections between the nerve and the blood vessel. Then he slipped aome padding between the two, like you'd slip a pillow between your head and the bed for cushioning.

“After surgery, his pain was instantly gone,” Citow said. “He recovered beautifully and was home in a few days.”