Trigeminal Neuralgia and Microvascular Decompression: A Cure for Facial Pain

I conducted a study on this myself — we took stem cells from the iliac bone and implanted them at the injury site in around 20 patients. One patient showed some improvement, but it couldn't be separated from natural recovery under medication, and statistically we found no significant benefit. We discontinued the trial. Stem cell therapy for complete spinal cord injury is still not recommended anywhere in the world; for partial injuries there may be some benefit, but meaningful recovery from stem cells in complete injuries has not been demonstrated.

Awake craniotomy, used for tumours near the motor cortex or speech areas, requires full patient cooperation throughout — some patients become agitated under partial sedation and we've had to convert to general anaesthesia. For international patients, a translator has to be present in the operating room the entire time, which adds another layer of difficulty. Personally I'm not very keen on it given how demanding it is for the patient; we now prefer using preoperative functional MRI to map eloquent areas and then operate under general anaesthesia while avoiding those mapped regions, which reduces the need for awake craniotomy in many cases.

Small vertebral hemangiomas are benign and don't require treatment unless they cause problems. If it's a large hemangioma involving the pedicle, causing vertebral body destruction, or resulting in a fracture or neural compression, then decompression and spinal fixation are required. Share the MRI report with the Jivo team and we can assess based on size and extent.

Communication is key. I'd suggest two things: topic-oriented sessions on one specific subject at a time — lumbar spine surgery, or brain tumours — where everyone shares experience and problems and we learn from each other, since doctors from Africa and India face similar socioeconomic challenges. And continuous feedback after a patient returns home: the local doctor monitors recovery and communicates with us on repeat imaging and medication adjustments. That collaboration, by WhatsApp or email at any time, directly improves outcomes.

For intractable epilepsy, we prefer other surgical methods first — removing an identified lesion (medial temporal lobectomy, or hemispherectomy in appropriate cases). If no focus is identifiable and epilepsy remains uncontrolled, electrodes can be placed in the anterior thalamus, with roughly 70 to 80% success; vagal nerve stimulation is the alternative. For psychiatric disorders we have done some frontal DBS placements, but results are variable, the procedures are not curative, and patients still need to continue medication.

Vascular or tumour compression of the nerve at its root entry zone.

No, but it is one of the most severe pain syndromes in clinical medicine, leaving patients unable to eat, brush their teeth or carry out normal daily activities.

Medication such as carbamazepine helps initially, but higher doses over time bring sedation, cognitive effects and bone marrow suppression, at which point patients unhappy with their quality of life become surgical candidates.

A small posterior fossa craniotomy in which the cerebellum is gently retracted, the fifth cranial nerve identified, and the offending blood vessel, sometimes more than one, separated from the nerve with a small Teflon graft.

Results are excellent. Patients can typically stop all medication within a few weeks of surgery and are completely relieved of pain.