All Smiles, No More Pain

UH neurosurgeon helps mom and healthcare worker get back to quality of life with first-in-the-world trigeminal nerve ablation procedure.

Natisha “Tish” Long, 44, can smile again thanks to a first-in-the-world procedure now offered at University Hospitals.

The pain began in 2018 when Tish started experiencing trigeminal neuralgia (TN) in her right cheek and jaw. The pain was minor at first but continued to increase over time.

TN is a debilitating, chronic syndrome that causes sudden, severe, electric shock-like pain in the face. While not life-threatening, it can severely alter quality of life and disrupt everyday activities, such as talking, chewing and smiling by triggering intense bouts of pain. The condition occurs when a blood vessel puts pressure on the trigeminal nerve near the brainstem, which provides sensation to the face and head. This can occur genetically or as a result of trauma, such as getting a tooth pulled.

“It was hard for my doctor to diagnose me at first,” Tish remembered. “We tried medication after medication, but the pain never really went away.”

Tish lives in Elyria with her family. The constant pain and tiredness she felt was not sustainable for her lifestyle, as Tish is a mother of four children and also helps care for her parents. A medication aide who works in the healthcare field, she also knew that being on so many medications was not sustainable long-term.

“I was functioning because I had to, but I was so drowsy,” Tish said. “When I got home from work, I would usually just fall asleep. The days I was off work, I had to make sure to keep myself standing and walking around so I wouldn’t get too tired.”

Her doctors tried microvascular decompression surgery and it went well. However, after two years the pain began again.

Tish was in search of another treatment option, and thankfully her primary care provider referred her to neurosurgeon Michael Staudt, MD, the Lincoln Endowed Chair in Brain Health at University Hospitals and an Associate Professor of Neurological Surgery at Case Western Reserve University School of Medicine.

Dr. Staudt presented her with three different treatment options, including a new, minimally invasive option with the OneRF^® Trigeminal Nerve Ablation System. University Hospitals was the first health system in the world to offer it. Tish liked this option best because it was an outpatient procedure with instant results, and she became the first patient in the world to be treated with the new technology.

“During the procedure, a needle is inserted through the cheek, guided by X-ray, to the trigeminal (Gasserian) ganglion. Radiofrequency energy is used to create controlled heat lesions, or partial ablation, in specific nerve fibers that transmit pain. Patients are sedated during the procedure and woken up to confirm the areas of treatment,” Dr. Staudt explained. “This type of surgery has been performed for many decades with a radiofrequency probe, although this requires waking the patient up multiple times during the surgery and is only capable of testing and treating one pain distribution at a time. This new ablation probe is a step forward for our patients. It is a multi-contact probe designed to test and treat multiple nerve distributions without the need for repositioning. It also simplifies hardware with a unified setup, because typically multiple components from different manufacturers are needed.”

Ideal candidates for the surgery are patients with TN who haven’t had success with medications and have symptoms in the cheek and jaw. Those who prefer a more minimally invasive procedure compared to open brain surgery, as well as older patients or those with medical comorbidities, are also good candidates for this treatment option.

Following the procedure, Tish’s pain went away immediately, and she was back at work within a week.

“I do a lot of research on my own when it comes to my health, and I’ve seen TN referred as a suicide disease,” she said. “I’m so glad I found this procedure and got my smile back. It completely changed my life. I feel back to 100 percent and like myself again.”