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Practical algorithm for surgical management of facial pain
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Practical algorithm for surgical management of facial pain

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  • 1. © Slavin et al., 2007Practical Algorithm for Surgical Management of Facial Pain Konstantin V. Slavin, M. Efkan Colpan, Naureen Munawar, and Hrachya Nersesyan Section of Stereotactic and Functional Neurosurgery University of Illinois at Chicago
  • 2. © Slavin et al., 2007 Rationale for algorithmFacilitates decision makingAimed at maximal improvement / minimal side effectsIndividually tailored approachStandardizationEliminates uncertaintyPatient and physician education
  • 3. © Slavin et al., 2007
  • 4. © Slavin et al., 2007 Facial pain classificationTrigeminal neuralgia (classic–Burchiel TN 1)Trigeminal neuralgia (atypical–Burchiel TN 2)Symptomatic trigeminal neuralgia (MS, tumors)Trigeminal deafferentation pain (iatrogenic)Trigeminal neuropathic pain (trauma, infection)Cancer facial pain (w/ short life expectancy)Other cranial neuralgias (GPN, n. intermedius)Atypical facial pain (psychiatric diagnosis)
  • 5. © Slavin et al., 2007Treatment modalitiesMicrovascular decompressionRadiofrequency gangliolysisBalloon compressionStereotactic radiosurgeryPeripheral nerve stimulationNeurectomyMotor cortex stimulationTractotomySurgery on other cranial nervesNo surgery
  • 6. © Slavin et al., 2007 Initial questionsDistribution of painMRI findingsNature of painPresence of numbnessPrevious surgery
  • 7. © Slavin et al., 2007 Treatment questionsHealthy? Young?Willingness to have surgeryDistribution of painSeverity of numbnessExact pain location
  • 8. © Slavin et al., 2007
  • 9. © Slavin et al., 2007Current Algorithm of Facial Pain Treatment ~ 100 new patients with facial pain/year ~ 65% - trigeminal neuralgia ~35% - typical idiopathic TN ~15% - atypical idiopathic TN ~15% - secondary TN (MS, neoplasms, etc.) ~ 15% - trigeminal neuropathic pain ~ 5% - other cranial neuralgias / syndromes ~ 15% - atypical facial pain
  • 10. © Slavin et al., 2007Current Algorithm of Facial Pain Treatment ~ 70 surgeries for facial pain /year ~30 microvascular decompressions ~25 percutaneous RF gangliolysis ~2-3 balloon compressions ~15 GK radiosurgery ~3 trigeminal peripheral nerve stimulation ~1-2 motor cortex stimulation
  • 11. © Slavin et al., 2007Current Algorithm of Facial Pain Treatment 96% pain relief (at the time of discharge) 23% overall recurrence rate ~15% need another procedure 98% patient satisfaction
  • 12. © Slavin et al., 2007Current Algorithm of Facial Pain Treatment The proposed treatment algorithm for intractable facial pain that includes open and percutaneous procedures, radiosurgery and neuromodulation, appears to be effective for patients with a wide variety of painfulThis algorithm has been published in a conditions and may bepeer reviewed journal and is available for recommended for use indownload and use free of charge atwww.biomedcentral.com other institutions.

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