Advanced neurosurgery helps treat Mumbai woman with severe bilateral facial pain

Mumbai: A team of Mumbai doctors have successfully treated a 56-year-old woman with Bilateral Trigeminal Neuralgia, the first in India to suffer from severe facial pain on both sides of the face, via an advanced neurosurgery.

"Primary Bilateral Trigeminal Neuralgia is extremely rare, with an incidence ranging from 0.6 to 5.9 per cent. 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 MicroVascular Decompression (MVD) was performed, resulting in complete pain relief," said Jaslok Hospital and Research Centre, in a statement on Thursday.

The patient, Kiran Awasthi, a housewife hailing from Maharashtra was presented to the doctors at Jaslok with a five-year history of severe, shock-like pain on both sides of her face, endured excruciating episodes that lasted several minutes and was 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 the extent that it led to the development of suicidal thoughts.

In October 2023, an MRI scan revealed vascular loops compressing her trigeminal nerves (fifth cranial nerve) on both sides, diagnosing her case as Bilateral Primary Trigeminal Neuralgia.

"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 MicroVascular Decompression, the first in India. Seeing our patient regain her quality of life after five years and live pain-free is the greatest reward," said Raghvendra Ramdasi, Neurosurgeon at Jaslok Hospital.

While medications such as Carbamazepine, Gabapentin, Lamotrigine, and Topiramate can offer relief, MicroVascular Decompression (MVD) remains the gold standard treatment.

The surgical procedure involves placing a Teflon sponge between the nerve and the compressing vessel.

Kiran was initially operated 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," the doctor said.

Thanking the doctor for "gifting a new life", Kiran said she was "brought from the doors of death. I was about to commit suicide as the pain was unbearable".