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If you have been experiencing severe or chronic facial pain in the Dallas area, acclaimed neurosurgeon Dr. Nader Pouratian can help. When traditional therapies and medications create undesirable side effects or do not offer satisfactory relief, Dr. Pouratian can perform various advanced procedures to relieve facial pain. Most neurosurgeons only treat trigeminal neuralgia (please add link to my trigeminal neuralgia page). However, Dr Pouratian offers options for all varieties of chronic facial pain.
Peripheral Facial Stimulation
Peripheral stimulation of the face is a neurosurgical procedure that entails placing small stimulating wires in the face in the region of pain. When pain is well localized, particularly above or below the eye, this type of stimulation can be very effective. The stimulation works to “mask” the pain and make the pain less bothersome. Before committing to the procedure and the implant, patients undergo a trial in which temporary wires are placed through the skin to determine if the stimulation will be helpful. If there is at least 50% pain relief, a permanent implant may be recommended, which includes both the wires under the skin in the area of pain as well as a battery in the chest. The entire implant is under the skin
Peripheral facial stimulation is regarded as a safe process and has few notable side effects. However, this is an off-label use of a device. Risks include infection and the possibility that the wires can move, both of which may require additional surgeries to correct. Because a device is implanted for this procedure, there is a need for long-term maintenance and programming.
Deep Brain Stimulation
Deep brain stimulation involves placing electrodes deep within the brain. This procedure is most often used for patients with Parkinson disease or essential tremor. The use of deep brain stimulation for facial pain is considered off-label.
The goal of the surgery is to precisely place the electrode in the part of the brain where pain signals travel through. Stimulation is delivered to interrupt that pain signal, often resulting in a tingling feeling in the face. The entire device is implanted under the skin, and includes the wire in the brain as well as the battery in the chest. Because this is a stimulator, it requires long term maintenance and programming. The procedures is effective in about 50% of patients and has risks of infection (~2%).
A cingulotomy is a neurosurgical procedure that specifically targets the tissue in the part of the brain that feels chronic or severe pain. A person may opt for a cingulotomy when they experience any of the following:
- Non-malignant chronic neuropathic facial pain (such as post-stroke pain)
- Pain related to cancer
First, you will undergo a specialized MRI so that the anatomy of your brain can be mapped. The MRI is used to guide the surgery.
Anesthesia is administered. Probes are placed in the anterior cingulate region of the brain. Dr. Pouratian then carefully creates a lesion on both sides of the brain by administering radiofrequency energy to the targeted regions.
A cingulotomy is regarded as a safe process and has few notable side effects. Because no device is implanted for this procedure, there is no requirement for any long-term maintenance, battery replacements, or programming.
Schedule a Consultation
To discuss Dr. Nader Pouratian’s state-of-the-art treatment options for facial pain in Dallas, Forth Worth, or North Texas, contact our office and schedule your consultation. Dr. Pouratian is able to provide the pain relief you deserve and can answer any questions you may have.