The Neuroscience Center of Central Jersey at CentraState offers comprehensive care for brain, spine, and nervous system conditions. Through a personalized approach, our neuroscience and neurosurgeon experts provide treatment that focuses on all aspects of a patient’s well-being from diagnosis through management.
At CentraState, we provide individualized care for a wide range of neurological conditions, including:
ADVANCED DIAGNOSTICS AND TREATMENT
This rare disorder, also called tic douloureux, causes recurring episodes of sharp, shooting facial pain, usually on one side of the jaw or cheek. Episodes can be severe and unpredictable, and they can last a few seconds or up to a few minutes.
At CentraState Medical Center, patients have access to the gold standard treatment for trigeminal neuralgia: microvascular decompression (MVD).
Causes of Trigeminal Neuralgia
Trigeminal neuralgia is caused by irritation of the trigeminal nerve, one of the 12 pairs of cranial nerves that exit directly from the brain. The condition is often the result of a blood vessel pressing down on the nerve, which can happen naturally with age. Much less frequently, trigeminal nerve pain is related to conditions such as:
- Multiple sclerosis or other disorders that cause damage to the myelin sheath that covers certain nerves
- A tumor compressing the trigeminal nerve
- Injury to the trigeminal nerve
Trigeminal neuralgia most often occurs in people over age 50, but it can happen at any age. It’s more common in women than in men. Trigeminal nerve pain can strike for days, weeks, or months at a time and then go away for months or years before returning.
Diagnosis and Treatment for Trigeminal Neuralgia
Trigeminal neuralgia can be challenging to diagnose because of the many causes of facial pain. Your physician may order imaging tests, such as magnetic resonance imaging (MRI), CT scans, or X-rays, to help rule out other causes of pain.
Pain medication is the first treatment option for trigeminal neuralgia. Complementary therapies such as biofeedback, acupuncture, and electrical nerve stimulation may also help. If these therapies fail to provide adequate pain relief or cause unwanted side effects, then trigeminal neuralgia surgery may be an option. The most effective procedure is microvascular decompression (MVD), which has been shown to relieve pain for most patients.
Microvascular Decompression Surgery
During microvascular decompression, a neurosurgeon uses advanced microscopes and surgical tools to gently move the blood vessel causing irritation to the trigeminal nerve. A few soft, customized pads hold the blood vessel away from the nerve to prevent future irritation. The procedure is performed using small incisions and minimally invasive techniques, and the majority of patients are back to most normal activities within days.
Occipital neuralgia is a condition that causes a very distinct type of headache—a continuous aching, burning, and throbbing with occasional electric-shock-like or shooting pain. It happens in the upper, back part of the head and neck or behind the ears, usually on one side of the head.
The pain is due to irritation or injury to the occipital nerves, which are two pairs of nerves that originate in the base of the neck and run up through the scalp at the back of the head. While occipital neuralgia is relatively common, it can often be misdiagnosed as a migraine or other type of headache
At the Neuroscience Program of Central Jersey at CentraState, our physicians are experts in determining the cause of chronic headaches, including occipital neuralgia. Our neurosurgeons are also among New Jersey’s leaders in providing a highly effective surgical procedure for occipital neuralgia called rhizotomy, which lessens or eliminates pain for many patients.
Causes of Occipital Neuralgia
The two greater occipital nerves, one on each side of the head, are responsible for most of the feeling we have in the back and top of the head. Occipital neuralgia results from injury or irritation to one or both of those nerves. Some of the more common causes of occipital neuralgia include:
- Trauma to the back of the head, such as whiplash from a car accident
- Pinching of the nerves due to overly tight neck muscles, sometimes from keeping the head in a downward position too often
- Compression of the nerves due to arthritis, tumors, or other lesions in the neck and spine
- Infection or blood vessel inflammation at the site of the nerves
- Conditions that cause nerve pain, such as diabetes
In many cases, the cause of occipital neuralgia cannot be determined, even after a diagnosis is made.
Occipital Neuralgia Treatment
Treatment of occipital neuralgia is aimed at reducing the frequency and intensity of pain. Mild cases can often be managed with rest, physical therapy, anti-inflammatory medications, or muscle relaxants. Anti-depressants and anti-seizure medications are also effective for some patients. In addition, local anesthetic nerve blocks and steroid injections can be used to temporarily reduce pain.
If these therapies are not effective, surgery may be an option for some patients. At CentraState, our board-certified neurosurgeons are helping patients control their pain through rhizotomy.
During rhizotomy, the affected nerve is surgically cut, which stops pain signals from traveling from the nerve to the brain. The procedure causes numbness in the back of the head and reduces or eliminates pain for many patients.
A Chiari malformation is a problem with the position of the cerebellum, the part of the brain that controls balance, movement, and coordination. The cerebellum and parts of the brain stem are normally in a space in the lower back part of the skull. A Chiari malformation happens when the cerebellum and brain stem are pushed downward into the spinal column.
A Chiari malformation puts pressure on the cerebellum and brain stem, which can cause dizziness, weakness, and other neurological symptoms. It can also block the flow of cerebrospinal fluid, a clear liquid that surrounds and protects the brain and spinal cord.
While some Chiari malformations can develop over time, most are caused by structural problems in the brain at birth. This includes Chiari type 1 and type 2 malformations. Chiari type I malformations, the most common type; symptoms are usually first noticed during adolescence or adulthood. Chiari type II malformation symptoms usually appear during childhood.
Many patients with Chiari malformations have no symptoms, while others have minor pain, which can be controlled with medication. For patients with more severe symptoms, CentraState offers an advanced procedure called sub-occipital decompression. The procedure is helping patients with this potentially disabling disorder get back to their full, active lives.
Chiari Malformation Symptoms
The spinal cord directs communication between the brain and the rest of the body. Abnormal pressure from a Chiari malformation compresses the spinal cord, which can lead to any number of neurological symptoms. Symptoms often depend on the severity of the condition and which parts of the brain and brain stem protrude into the spinal canal.
Some of the more common symptoms include:
- Neck pain or stiffness
- Balance problems
- Muscle weakness and unsteady gait
- Numbness or other abnormal sensations in the arms and legs
- Difficulty swallowing
- Vision problems and ringing in the ears
- Headaches that get worse with exertion
- Dizziness or vertigo
- Loss of bowel or bladder control
While Chiari malformations are relatively rare, they are more common in women than men.
Your doctor may suspect the condition based on your symptoms and a neurological exam. A Chiari malformation is confirmed with medical imaging studies like MRI scans, CT scans, or myelography, a procedure that uses real-time X-rays to evaluate the spinal cord, nerve roots, and spinal lining. Electrodiagnostic studies may also be performed to determine whether the spinal cord and brain stem are working properly.
Chiari Malformation Treatment
For patients with severe Chiari malformations, surgery is the only option to correct symptoms caused by spinal compression and to stop any further damage. The goal of surgery is to relieve pressure on the brain stem, cerebellum, and spinal cord by creating more space around those structures.
Sub-occipital decompression surgery enlarges the posterior fossa, the canal that connects the brain and spine. This allows the brain to sit properly above the spinal column, which relieves pressure on the cerebellum and nearby nerves. The surgery is sometimes accompanied by the implantation of a shunt, a tube that can restore the normal flow of cerebrospinal fluid.
With the help of post-surgery physical therapy, many patients experience significant relief—if not a complete cure — for their symptoms.
Vasko Gulevski, M.D.
Caren Marks, M.D.
MS Center, Neurology
Susan Lage, D.O.
Caren Marks, M.D.
MS Center, Neurology
Arun Nangia, M.D.
Rajat Kumar, M.D.
Lewis Milrod, M.D.
Nazer Qureshi, M.D.
Steven Fulop, M.D.
Terence McAlarney, M.D.
MS Center, Neurology
Mohammad Padela, M.D.
Lisa Shultz, M.D.
Paul Kostoulakos, DO
Maria Choy, M.D.
Michael Moussouttas, MD
Boris Furman, D.O.
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