A Neurosurgeon's High-Stakes Game of Hide-and-Seek

A delicate surgery could stop a woman's crippling pain from trigeminal neuralgia — or threaten her life.



Neurosurgeons live for the “great saves.” Our specialty is accustomed to more than its share of depressing outcomes, from lives cut short by brain tumors to minds devastated by head injury. Any neurosurgeon relishes the opportunity for a great save — a total cure or a dramatic neurological reversal. The elation of such a moment helps inoculate the surgical psyche against gloomier endings.

So when Christine, a quiet woman in her 50s, walked into my office, I was pleased to recognize — after speaking with her for only five minutes — that I had a chance to relieve her of an agonizing affliction. She would be my next great save.

Christine had a relatively rare disorder called trigeminal neuralgia, and she had a severe case of it. This disorder, also known as tic douloureux (“painful tic” in French), can be so devastatingly painful that some call it “suicide disease.” Christine suffered from excruciating and unpredictable bouts of stabbing, electric-shock-like facial pain that might last seconds or minutes and could be triggered simply by chewing, sipping a cold drink or exposing her face to a winter breeze. The medications she took for the condition were becoming less effective, even at near-toxic doses.

Sitting in my exam room, Christine told me the pain was so frequent and severe that it was ruining her life, keeping her constantly on edge because she never knew when it might strike. “I had to quit my job,” she said. “I worry every time I get behind the wheel. I haven’t even been out to lunch with my friends for over a year. I don’t want to make a scene at the restaurant.” Her talking triggered an attack, and she clutched the right side of her face and collapsed forward in her chair for a good 20 seconds, breathing heavily. Drained, she sat back up, and I nodded as sympathetically as I could, never having experienced a similar pain myself.

“I’ll continue with yes-or-no questions,” I explained. “Let me do the talking...”

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VIDEO: Watch how the surgery is done. Microvascular decompression procedure for trigeminal neuralgia.


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