Vaishali Karmarkar, a 78-year-old woman living in the city of Pune, India, was suffering from V2-V3 electric shock-like pain on her face. She had no idea why this condition was affecting her, a condition that began 5 years ago. In the span of 5 years, her pain kept increasing. What started as a small electric sensation turned into full-blown shock-like pain. It became so frequent and unbearable that she couldn’t talk, eat or smile.
Her health history showed that she was diagnosed with Anterior Inferior Cerebellar Artery (AICA) pressing the root entry zone (REZ) of the fifth nerve, along with two failed RFTC procedures. Her condition became so worse that she became emaciated, depressed and dependent on her daughter.
A Rare Finding, A Successful Treatment
When Vaishali couldn’t find a concrete solution after multiple consultations, she was finally referred to Dr. Raghvendra Ramdasi, all the way to Mumbai. She took the long journey from her home city Pune, hoping that this time fate would give her some relief.
Known as one of the most reliable neurosurgeons in Mumbai, Dr. Ramdasi has extensive experience solving the rarest cases in the field of neurology/neurosurgery. From Pituitary Adenomas to Subdural Hematomas, he has worked on thousands of cases in this 20+ years of practice with a success rate of 99%.
After meeting Dr. Ramdasi, she relayed all her issues and medical history to him. A thorough consultation led them to conduct a retrosigmoid MVD under neuromonitoring. What they found was astonishing- an AICA loop, densely adherent to the REZ by thick arachnoid bands, but what caught their eye was a hyperdynamic, visibly disturbed flow right at the adhesion, indicating that this was a rare neurology case.
Turns Out It Was Trigeminal Neuralgia
These findings brought them the clarity they needed for effective treatment. Vaishali was booked for surgery under the care of Dr. Ramdasi. The surgery was fairly simple, with meticulous dissection and Teflon interposition, her pain stopped immediately.
We can see the difference in the video below:
With time, Vaishali recovered fully. She was able to talk, eat and smile for the first time in 5 years.
What Is Trigeminal Neuralgia?
Trigeminal Neuralgia is a chronic neurological pain disorder that affects the facial muscle. This happens when the ‘trigeminal nerve’, which carries sensation from the brain to muscle, gets affected, clogged or hindered, resulting in extreme electric shock-like or stabbing pain to the face. Often a blood vessel indents/contacts the trigeminal REZ (classically the SCA; AICA can also be responsible), leading to ephaptic irritation and paroxysmal pain.
However, modern studies evaluate this further and show that not just blood vessel, but also the blood flow matters. Computer models show that strong, uneven blood flow puts extra stress on the nerve and this stress reduces after surgery that separates the vessel from the nerve. Advanced MRI scans can now actually measure the ‘pulsing flow’ in these arteries, helping understand why some people develop trigeminal neuralgia.
That being said, in Vaishali’s case, the RFTC treatment failed because RFTC treats the symptom pathway but doesn’t remove the pulsatile mechanical/hemodynamic driver. MVD on the other hand directly addresses the offending vessel, with strong long-term outcomes in suitable patients.
Dr. Ramdasi’s Steps To Treating Trigeminal Neuralgia
Treating Trigeminal Neuralgia requires deep understanding of the root problem. Hence, at Dr. Ramdasi’s clinic in Mumbai, his team first begin with thorough research.
Step 1:
- The first to treating trigeminal neuralgia is to conduct high resolution MRI (CISS/FIESTA + MRA).
- This help identify neurovascular contact and plan surgery.
Step 2:
- Medications (carbamazepine/oxcarbazepine) for early diagnosis.
- Microvascular Decompression (MVD): Gold-standard surgical option when vascular compression is demonstrated. This technique focuses on atraumatic arachnoid dissection, precise vessel mobilization, and Teflon interposition- with neuromonitoring to protect hearing and cranial nerve function. (Long-term outcomes of MVD are excellent in appropriately selected patients.)
- Other options (radiofrequency rhizotomy, GKRS) may suit select patients, especially if imaging doesn’t show a clear arterial offender or if comorbidities preclude posterior-fossa surgery.
The treatment plan above is not standard and is modified/changed based on the patient’s needs, symptoms, medical history etc.
Trigeminal Neuralgia Treatment & Surgery in Mumbai — Get The Right Diagnosis, Then The Right Fix
Neurological disease is best treated early through early diagnosis and care. If you or your loved ones are looking for one of the best doctors for Trigeminal Neuralgia in Mumbai, then you can book a consultation with Dr. Raghvendra Ramdasi.
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