Trigeminal neuralgia, also known as tic douloureux, is a neurological disorder affecting the trigeminal nerve, the nerve that carries sensory information from the face to the brain. This chronic condition causes severe, shooting pain in the face, sometimes as fleeting, momentary twinges, other times as frequent bouts of excruciating pain. Because the trigeminal nerve is responsible for sensation all around the face, including the eyes, mouth and sinus cavities, trigeminal neuralgia can result in pain on one side of the jaw, cheek or mouth, or, less frequently, near the forehead or one of the eyes.
The pain usually comes on suddenly and, although it lasts from a few seconds to a few minutes, may be physically and mentally incapacitating. When the pain occurs along the cheek or jaw, it is sometimes mistaken for a severe toothache.
Episodes may be triggered by activities that cause a vibration in the cheek, such as shaving, brushing the teeth, applying makeup, eating, drinking or talking, or even encountering a slight breeze. As the condition progresses, the episodes of pain may become longer and more frequent.
A subdural hematoma is a blood clot that develops near the brain. These blood clots are known as subdural hematomas because they form under the dura, which is the protective covering of the brain. Hematomas usually require removal because they can compress the brain tissue and cause life-threatening complications. In some cases, a hematoma can successfully be drained by creating a small perforation in the skull called a “burr hole.” But, when the subdural hematoma is larger or more severe, an open surgical procedure known as a craniotomy is required.
Chiari malformation (CM) is a structural abnormality in the brain in which the cerebellum is located in a lower position than usual. This happens when the skull is abnormally small or misshapen. Under normal circumstances, the cerebellum is situated at the lower rear of the skull, above the foramen magnum (the opening to the spinal canal). When Chiari malformation occurs, the cerebellum is located below the foramen magnum. In this location, more pressure is exerted on the cerebellum and medulla (brain stem), and the functions they control, including balance and motor control, may be adversely affected. This condition may be congenital or develop as the patient grows and it may or may not result in symptoms.
Craniotomy is a surgical procedure in which part of the skull is removed in order to view the brain. The piece of skull removed is called a “bone flap.” After the surgery is performed to remove the brain tumor, the bone flap is fitted back into the skull.
Surgery is often the most effective way to treat many brain tumors, whether they are benign or malignant. Craniotomies, which are performed by neurosurgeons, are designated in different ways. A frontotemporal, parietal, temporal or suboccipital craniotomy is named after the bone that is removed.
In order to accurately access the tumor and reduce the risk of damage to healthy brain tissue, imaging devices may be used to help guide the surgeon. Known as a stereotactic craniotomy, scans are taken that create a three-dimensional image of the brain. A computer provides a navigation system to safely route the surgeon to the precise location of the tumor.