Procedure, new to Meritus, used to treat debilitating facial pain

HAGERSTOWN, Md. — The 95-year-old woman was complaining of pain in her jaw.

But rather than going to the dentist to get relief, she went to Meritus Neurosurgery.

There, Chikezie Eseonu, M.D., treated her trigeminal neuralgia in early April with a procedure not performed at Meritus before.

Trigeminal neuralgia is a chronic pain condition where patients experience sudden and severe facial pain. Dr. Eseonu said it is often along the jaw line, leading some to think the cause is dental-related.

The pain can be so severe and debilitating that some cases have led to suicide, Dr. Eseonu said.

The pain is caused usually when a blood vessel puts pressure on the nerve in the brain that is responsible for sensations in the face.

Typically, treatment starts with medication, Dr. Eseonu said.

“When that’s no longer working, the next option is neurosurgery to help alleviate the pain,” he said.

There are three types of neurosurgery that are used to treat trigeminal neuralgia: surgery, rhizotomy and radiosurgery. Surgery involves opening the skull and manually moving the blood vessel or severing the nerve that is causing pain. Rhizotomy involves using a needle to deliver a chemical that destroys the nerve.

Both are relatively common and successful.

But radiosurgery is noninvasive. The procedure had only been performed in this region at Johns Hopkins Hospital in Baltimore and Penn State Health in Pennsylvania, Dr. Eseonu said, adding that he was trained in the procedure at Johns Hopkins.

Typically, it is reserved for people who, due to illness, are unable to tolerate the other two options. But Dr. Eseonu said there’s nothing preventing anyone from using it.

Dr. Eseonu performed imaging scans on the patient to map out the location of the nerve. Then he coordinated with Ashima Saini, M.D., a radiation oncologist with the John R. Marsh Cancer Center at Meritus Health, who used a specialized machine called TrueBeam to target the trigeminal nerve.

“The treatment site is probably 5 or 6 millimeters,” Dr. Saini said. “It’s also a super high dose of radiation as compared to more routine radiation treatments.”

The machine fired multiple, pin-point radiation beams from different angles, all converging on the nerve, burning it. This prevented other parts of the brain from being damaged by the radiation.

The patient was put in a special mask bolted to the operating table to immobilize her head, Dr. Saini said.

The procedure took about 45 minutes, and the patient was able to go home the same day.

Relief usually takes two to three months, though it can happen sooner, Dr. Eseonu said.

According to the doctors, the patient seemed to tolerate the procedure well, but it was not having to travel out of the area that was the selling point.

“They wanted a local option,” Dr. Eseonu said of the patient and her family.

Primary care providers or pain management specialists can refer patients possibly suffering from trigeminal neuralgia to Meritus Neurosurgery, he said.

To learn more or to contact the office, visit MeritusHealth.com/Neurosurgery.

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Meritus Health, Western Maryland’s largest health care provider, is located at the crossroads of Western Maryland, Southern Pennsylvania and the Eastern Panhandle of West Virginia. The mission of Meritus Health is to improve the health of the region by providing the best healthcare, health services and medical education. As an anchor organization for the community, Meritus has 4,000 employees and serves more than 200,000 residents of the tristate region through Meritus Medical Center, Brook Lane Health Services, Meritus Medical Group, Meritus Home Health, Meritus Equipped for Life, and the Meritus School of Osteopathic Medicine. More information can be found at www.MeritusHealth.com or visit our Facebook page or LinkedIn page.