At 27 weeks pregnant with her second child, Jessica G. was in such severe facial pain that eating, drinking and even talking was unbearable. She was losing weight, weary and extremely concerned about not being able to nourish her unborn daughter. She was also at her wit’s end in her battle with trigeminal neuralgia, a chronic condition characterized by sudden, stabbing pain in the face, which she was diagnosed with three years prior.
“Trigeminal neuralgia is extremely rare, but I’ve learned the misdiagnoses and challenges I’ve faced over the past few years are not,” says Jessica. “In addition to the physical pain, which feels like an intense electric shock shooting through your face, it was such a painful road to figure out what I was actually dealing with. So many doctors looked at me like I was crazy. Meanwhile, I was spiraling in pain and desperate for help.”
When Jessica first began experiencing these intense shocks, her dentist recommended a root canal. She had the procedure, but the pain persisted. An oral surgeon then removed one of her back teeth to address a nerve, but the pain continued.
After many frustrating and unproductive doctor’s appointments, Jessica started her own research. She discovered her symptoms closely resembled those associated with trigeminal neuralgia. Finally, she was referred to Richard S. Rosenberg, MD, a neurologist who confirmed the diagnosis and prescribed medication to keep the condition under control.
“Things were going well for a while. I stopped taking the meds when I got pregnant the second time because I was actually in remission,” Jessica explains. “Several months later, the pain came back with a vengeance. I started the medication again, but it didn’t come close to touching the pain. It was so intolerable that I isolated myself and could barely take a sip of water. I had no idea what to do.”
After not being able to have any food or water for five days, Jessica’s OB/GYN, Craig L. Bissinger, MD, admitted her to Morristown Medical Center where she received IV nutrition while neurologists worked to devise an alternate medication plan. Dr. Bissinger also suggested she be evaluated by neurosurgeon and co-director of Atlantic Health System’s Gerald J. Glasser Brain Tumor Center Yaron A. Moshel, MD, PhD.
“Unfortunately, the medications weren’t doing anything to help Jessica,” says Dr. Moshel. “We could see from an MRI scan that part of a critical blood vessel that feeds the brainstem and cerebellum, called the Anterior Inferior Cerebellar Artery (AICA), was pressing against the trigeminal nerve root entry zone at the top of her brainstem.”
A pulsating blood vessel pressing on the nerve in a vulnerable spot is referred to as microvascular compression. There are several microvascular compression syndromes, trigeminal neuralgia being one of them.
“This compression can cause debilitating shock-like or stabbing pains that come on seemingly out of nowhere. Thankfully, there are several surgical and non-surgical treatment options for trigeminal neuralgia if medical management is not effective,” Dr. Moshel notes.
A team of neurosurgeons, neurologists and OB/GYNs at Morristown Medical Center collaborated closely to discuss and weigh the surgical options with Jessica and her family. Taking special precautions to deliver the best care for her and her unborn baby, they agreed on microvascular decompression surgery, which could provide immediate relief.
The surgery entailed making a small opening in the bone behind Jessica’s ear, carefully moving the AICA vessel away from the trigeminal nerve and tacking it to the side of the skull. A soft Teflon cushion was also inserted between the nerve and the artery to prevent nerve compression in the future.
“Surgery to access this deep location in the front of the brain stem can be very challenging. The need for good access and visualization needs to be carefully balanced with efforts to be as minimally invasive as possible and avoid any trauma to the brain,” Dr. Moshel explains. “Removing a portion of the bone at the bottom of the skull, aided by the use of extremely powerful microscopes and GPS-like navigation, gave us a straight-line angle of attack to the nerve while minimizing any manipulation of the surrounding brain. This skull base approach allows us to get to the deepest areas in the bottom of the skull and avoid damaging the brain … all with a two-inch incision.”
“I woke up from surgery and just like that, I got my life back,” Jessica explains. “I wasn’t in any pain, ate my first real meal in weeks and my baby was still healthy and growing. What the team at Atlantic Health System did for me was nothing short of miraculous.”
Jessica, her husband, Al, and big sister, Kenzie, joyfully welcomed their new addition, Layla, on December 23 at Morristown Medical Center.
“It’s always an honor to help parents bring healthy babies into the world,” says Dr. Bissinger. “Sometimes there are bumps in the road, but as Jessica’s story shows, we always do everything we possibly can to ensure mom and baby receive the best care. This team effort is a testament to just that.”
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