Jaslok Hospital Doctors perform Bilateral Micro Vascular Decompression on 56-year-old woman suffering from bilateral facial pain

The patient, with a five-year history of severe, shock-like pain on both sides of her face, endured excruciating episodes that lasted several minutes and were triggered by everyday activities such as talking, eating, brushing her teeth, and even exposure to a cool breeze. Despite various medical treatments, she found no relief because the disease was not diagnosed. The excruciating pain made it difficult to perform basic household duties to an extent that it led to the development of suicidal thoughts.

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Referred to Jaslok Hospital in October 2023, Dr Raghvendra Ramdasi diagnosed her with Bilateral Primary Trigeminal Neuralgia. An MRI scan revealed vascular loops compressing her trigeminal nerves (fifth cranial nerve) on both sides.

Primary Bilateral Trigeminal Neuralgia is an extremely rare, with an incidence ranging from 0.6% to 5.9%. To date, only about 24 cases have been reported in the English medical literature, with none from India. This case marks the first reported instance in India where Bilateral MVD was performed, resulting in complete pain relief.

The trigeminal nerve, or fifth cranial nerve, supplies sensation to the face through three divisions. Trigeminal Neuralgia is a chronic pain disorder characterized by sudden, severe facial pain, often described as electric shock-like. Typically unilateral, the condition affects one or more divisions of the trigeminal nerve. In about 85% of cases, the cause is a vascular loop compressing the nerve at its root entry zone.

While medications such as Carbamazepine, Gabapentin, Lamotrigine, and Topiramate can offer relief, Micro Vascular Decompression (MVD) remains the gold standard treatment. This surgical procedure involves placing a Teflon sponge between the nerve and the compressing vessel.

Under the leadership of Dr Raghvendra Ramdasi, Consultant Neurosurgery at Jaslok Hospital, the medical team including Dr Poornima Shah, Consultant Neurophysiology, Dr Rajani Prajish, Consultant Anaesthesiology, Dr Savi Kapila, Consultant Anaesthesiology performed Bilateral Micro Vascular Decompression, initially operating on the more severe left side, followed by the right side a week later. Post-surgery, the patient experienced complete pain relief, significantly improving her quality of life. Six months later, she continues to live pain-free, able to resume normal activities without fear of pain attacks.

Dr Raghvendra Ramdasi, Neurosurgeon at Jaslok Hospital, “Bilateral Trigeminal Neuralgia is often described as one of the most painful conditions a person can experience. This rare case was accurately diagnosed and hence treated with precision with Bilateral Micro Vascular Decompression, the first in India. Seeing our patient regain her quality of life after 5 years and live pain-free is the greatest reward. This case highlights the importance of expert diagnosis and the need for specialized care in managing rare conditions.”

Kiran Awasthi with joy mentioned “Dr Ramdasi is has brought me from the doors of death. I was about to commit suicide as the pain was unbearable. He has gifted me a new life”

Dr Paresh Doshi, Director of Neurosurgery, Functional neurosurgery and Stereotactic Neurosurgery, at Jaslok Hosptial, “The diagnosis of Primary Bilateral Trigeminal Neuralgia (PBTN) is a rare occurrence and the successful completion of bilateral MVD at Jaslok Hospital is definitely a commendable achievement. While the surgical procedure of Bilateral Micro Vascular Decompression (MVD)is well-established, Bilateral Decompressive Surgery is uncommon. ”

Dr Milind Khadke, Director Medical Services of Jaslok Hospital: “The successful treatment of Primary Bilateral Trigeminal Neuralgia with Bilateral Micro Vascular Decompression, the first in India, is a monumental achievement for Jaslok Hospital. We are proud of our team’s dedication to be vigilant in diagnosis of rare cases and thereby delivering life-changing results. I am delighted to see our patient walking out pain-free and continuing the same now for months”

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