Media Contact: Sandra VanE-mail: [email protected]Telephone: 1-800-396-1002
Not many patients suffering from trigeminal neuralgia would consider themselves lucky. Those afflicted say the facial pain is nearly unbearable when the trigeminal nerve -- the fifth cranial nerve -- becomes compressed in the brain.
In the case of Rodney Blauer, 68, a resident of Marina Del Rey, severe pain that developed in his left jaw last August led to the diagnosis of trigeminal neuralgia. Follow-up testing resulted in the accidental discovery of an unrelated tumor on the opposite side of his brain. That acoustic neuroma was completely removed in an endoscopic operation at the Skull Base Institute at Cedars-Sinai Medical Center.
When the jaw pain first struck, Blauer went to his dentist, who searched for a week to determine the cause. When the dentist suspected trigeminal neuralgia, he referred Blauer to a pain management center, where a physician ordered tests to rule out other possible culprits. An MRI revealed a large acoustic neuroma growing on the right side of Blauer's brain, causing right-side hearing loss that Blauer had dismissed as a normal part of aging.
"I might have been having symptoms going back a couple of years," says Blauer. "I said, 'Oh, well, my hearing is getting a little less on that side. It's probably from age.' And I had ringing in the ear but I never connected it. So I was real lucky that they found something on the other side."
Because acoustic neuromas arise from the nerve sheath of the 8th cranial nerve -- the vestibulo-cochlear nerve that travels from the brain to the inner ear -- one-sided hearing loss is by far the most common symptom. But other cranial nerves, particularly one affecting the face, are in close proximity. Therefore, while the tumors themselves are considered benign because they remain intact and do not metastasize to other organs, they can cause serious complications and eventually death as they grow, exerting pressure on nerves and on the brain itself.
To remove these tumors, surgeons have traditionally relied on one of two common approaches. The most frequently used procedure involves several surgeons who drill through the mastoid bone behind the ear to access the tumor. This direct, "translabyrinthine" approach is often considered the first choice for removing large tumors when there is no hope of preserving any remaining hearing in the ear.
For smaller tumors, the "retrosigmoid"or "sub-occipital" approach offers the possibility of saving some hearing. Instead of going through the mastoid bone, surgeons make a large incision behind the bone, open the skull, push the brain aside, and take the tumor out from the back.
Rodney Blauer's physician referred him to Hrayr Shahinian, M.D., director of the Skull Base Institute at Cedars-Sinai, who has developed a minimally invasive procedure that can be used to completely remove an acoustic neuroma of any size.
Instead of drilling through the mastoid bone or cutting a large opening in the skull, Dr. Shahinian made a burr hole the size of a dime behind the mastoid. From this point he inserted thin, flexible and precise endoscopic instruments, slipping them between the brain and the skull to the site of the tumor.
"One of the beauties of the endoscopic technique is that we don't have to put any retractors on the brain to move it out of the way," says Dr. Shahinian. "And we get an absolutely panoramic view. We can see much better than if we were looking in from the outside."
In fact, maneuvering scopes of varying thicknesses and lens angles, Dr. Shahinian can look into extremely tight spaces, even around corners. From within Blauer's skull, the lighted telescopes delivered highly magnified and crisp pictures to video monitors. Not only did this enable Dr. Shahinian to be sure he removed the entire tumor, he could easily identify and preserve vital structures such as the facial nerve. Unfortunately, Blauer's hearing in his right ear could not be restored.
"Going in behind the mastoid, if there is any potential for hearing preservation, we can save it," says Dr. Shahinian. "But Mr. Blauer's tumor was 3 1/2 centimeters. Anyone with a tumor of that size has already lost most of their hearing and there is no technique to bring it back." Any tumor greater than 2 1/2 centimeters is considered large.
Because the minimally invasive technique does not require the length of hospitalization or recovery typical of the traditional procedures, Blauer was able to resume his normal, active lifestyle quickly.
"The operation was done on a Monday morning and I got out of the hospital on Thursday about noon. As far as the recovery, I pushed myself the first week. I was out walking three times a day, two miles each time," he says. "It took me at least two weeks to really start to feel better about myself but from then on I started making quick progress."
Blauer's right eye was slightly droopy for a few weeks after the operation, a minor annoyance that Dr. Shahinian told him would be short-lived. "He almost called it to the day when it would come back," he says.
Also, Blauer's balance -- and his tennis game -- took some time to return to normal. "I was all over the place a little bit, not able to really focus and register. But after two months, I think that was back. By January of this year I was back pretty much all the way. I'm back to doing whatever I was doing before -- plus."
Blauer continues to take medication that controls the pain in his left jaw caused by trigeminal neuralgia. If his physicians had not ordered tests to confirm that diagnosis, the acoustic neuroma might still be growing undetected and causing even greater destruction.
"This is an extremely unusual situation. It is possible for a patient to get trigeminal neuralgia on the same side, caused by an acoustic neuroma pushing on the trigeminal nerve," says Dr. Shahinian, who coincidentally also offers a unique surgical approach for trigeminal neuralgia when medications fail. "But I have never seen anyone with neuralgia on one side and a tumor on the other."
# # #
For media information and interviews, please contact Sandra Van via e-mail at [email protected] or by calling 1-800-396-1002. Thank you.
RSS