A Team of doctors at Wockhardt Hospitals put the smile back on the face of B M Ramesh. Dr. Deshpande V Rajakumar, Consultant Neurosurgeon, Wockhardt Hospitals performed a minimally invasive Microvascular Decompression (MVD) surgery to relieve Ramesh of his facial pain. B M Ramesh, a 57 year old gentleman and a former journalist who hails from Mysore, was compelled to take early retirement from his job as he was suffering from excruciating pain on the right side of his face. He was suffering from this unbearable facial pain for the past 10 years and was under medication for a long period. But nothing really brought him relief and in due course of time he became refractory to even maximum dose of medication. Since then he continued to live with his pain, managing himself by avoiding the precipitating factors, restricting his social life to within home and the medication. He was barely able to speak, chew food as jaw opening and sensory stimulus to upper jaw triggered the pain on the right side. At times he even used to keep a piece of wood in between his teeth to avoid biting his own tongue due to sheer pain. Having suffered for so long Ramesh finally visited Wockhardt Hospitals where he was diagnosed with a neuro disorder called, Trigeminal Neuralgia, a disorder of one or both of the facial trigeminal nerves (the fifth cranial nerve, also called the fifth nerve or simply V which is responsible for sensation in the face) and was advised a minimally invasive surgery for the same.

According to Dr. Deshpande V Rajakumar, Consultant Neurosurgeon, Wockhardt Hospitals, Trigeminal neuralgia is an uncommon disease with an incidence 4.7 per 100,000 (prence of 155 per million) and occurs more frequently in the middle or later age groups, more in females than in males. It is more common on the right side of the face rather than the left side. It generally affects the lower jaw zone (mandibular) more than the upper jaw (maxillary). It was Ramesh courage that kept him going on for so many years. He added, that it is fortunate that 70-80% of patients respond well to medical therapy and can either be pain free or tolerably relieved of pain. Unfortunately 30% of the patients become refractory to it after 2years and some develop drug intolerance due to adverse effects. About half of all patients eventually require surgery for pain relief. Microvascular Decompression is the only surgical option that allows for obtaining long-term pain relief while avoiding any sensory disturbance. In our opinion, it still remains the treatment of choice for all patients with drug-resistant typical Trigeminal Neuralgia. Trigeminal Neuralgia is one of the worst known facial pains. The pain is paroxysmal or episodic in occurrence; each episode consists of a cluster of lancinating or electric shock like pains, severe to excruciating in intensity lasting from a few seconds to a few minutes and keeps recurring, at a variable frequency, leaving a pain free interval between the episodes. Microvascular Decompression (MVD) surgery is done through an approach behind the ear. A 5 cm long skin cut is made and a 3cm diameter bone is removed using a high speed drill. Now the covering of the brain is opened and the area of trigeminal nerve is reached with gentle retraction of brain (cerebellum), all this is done under high magnification using the microscope. The blood vessel compressing the trigeminal nerve near its entry into the brainstem is moved away and kept separated by interposing a Teflon patch in between. This patch prevents the pulsations of the blood vessel being transmitted to the nerve root. Now the brain covering is stitched back, bone is replaced and then the skin stitched. Ramesh was relieved of the pain immediately after being awake from anesthesia. He went home on the 3rd day after surgery. Microvascular Decompression has given him a new lease of life and he can look forward to his normal routine once again.

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