NEW YORK (Reuters) -- While surgery can be used to cure painful facial tics, most procedures also leave patients with permanent numbness due to damaged facial nerves. Now, researchers say a technique in which blood vessels are gently repositioned can relieve such tics without leaving patients numb, according to a report in the January issue of Neurosurgery.
The technique, called microvascular decompression, is designed to treat trigeminal neuralgia, or inflammation of the trigeminal nerve. The two trigeminal nerves originate in the base of the brain and extend down the jawline. Depending on which of the three nerve branches are affected, nerve inflammation causes spasms of extreme, stabbing pain in the eyes and forehead; the upper lip, nose, and cheek; or the side of the tongue and lower lip.
While conventional treatments relieve pain by damaging the nerve, in microvascular decompression, an operating microscope is used to move blood vessels that are putting pressure on the facial nerves.
In the new study of 1,204 patients treated with microvascular depression, only 17% had resulting facial numbness, according to lead study author Dr. Fred Barker II, of Massachusetts General Hospital in Boston. Indeed, those with more numbness were less likely to have relief for their facial spasms -- suggesting that nerve damage is not always a means to cure the condition.
Microvascular decompression can also be used to treat painful tics and muscle spasms caused by inflammation in other facial nerves, according to a second study in the same issue of the journal. In that study, researchers looked at 1,032 people with both trigeminal neuralgia and another tic disorder, hemifacial spasm, which is caused by pressure on the facial nerve.
They found the technique gave 80% of patients long-term relief of their muscle spasms, according to study author Dr. Akinori Kondo of the Kitano Medical Research Institute and Hospital in Osaka, Japan.
And the study found that an improvement in the surgery in 1987 reduced the number of people who suffered hearing damage after the operation from 7% to 4% of patients.
SOURCE: Neurosurgery (1996;40:39-52)
