Six years ago, when elementary school teacher Karen Pettinger first experienced shooting pain in her throat, she thought it was stress and weather related. "In the beginning years, as winter faded and the school year calmed down, the pain would go away," she said. "Eventually, it got worse and stayed with me longer." As time went on, the pain worsened and spread, encompassing the entire side of her face.
After seeing several ear, nose and throat specialists, she was ultimately referred to a neurologist who diagnosed Pettinger with trigeminal neuralgia, a disorder of a cranial nerve that caused the pain in her face. She was also diagnosed with glossopharyngeal neuralgia, a condition that caused the severe pain in her throat. The cause of trigeminal and glossopharyngeal neuralgia usually results from a blood vessel putting pressure on the nerve, causing a disruption in the nerve. The pain is often described as a "lightning-bolt" usually lasting less than a minute, but occurring throughout the day.
"The neurologist put me on medication that helped almost immediately," she said. For a couple of years Pettinger faithfully took the anti-seizure medicine. "It controlled everything beautifully – I had no pain – however there were some powerful side effects."
In the summer of 2014, the Pettinger family moved from Minnesota to Grand Rapids. "I felt fine until the middle of October when I caught a bad cold," she said. "The pain came on full blown in my face and throat. I was already on medication, but we had only been in Michigan five months so I hadn't found a neurologist yet." She saw several physicians before she connected with one who had experience treating trigeminal neuralgia. "He could control the facial pain but couldn't get the pain out of my throat," says Pettinger.
Pettinger said the pain would be relentless, intense and affected eating, speaking, sleeping and her ability to work. "It can deeply impact your life," she said. "I was on medication every four hours at one point."
Pettinger eventually underwent cranial surgery, brain surgery to decompress the nerve in hopes of relieving the pain. Initially the surgery appeared to reduce the pain and allowed Pettinger to reduce her medications. However, less than a year later, the pain was back.
"It happened all of a sudden and for no apparent reason," she said. "I started back on pain medication, but the pain was stronger and I was on the highest dosage I could tolerate. I knew I needed to do something. That's when my neurologist brought up Gamma Knife®."
Gamma Knife is a highly specialized radiation therapy technique with sub-millimeter accuracy. It relies on MRI images and/or CT scans, as well as 3D computer-assisted planning to target and desensitize the nerve with multiple beams (192 in total) of gamma radiation. Each individual beam emanates from a different location, meaning the tissue along the route to the lesion receives a harmless, low-dose beam. Together, all of the beams meet at the exact site of the lesion, causing it to receive a multiplied dose of radiation. Gamma Knife is able to treat deep within the brain without using a scalpel at all. Gamma Knife provides good to excellent results for 85-90 percent of patients, offering new hope to many trigeminal neuralgia patients. If the pain returns, the procedures can be repeated.
Dennis Ouillette, R.N., Gamma Knife Coordinator for MidMichigan Health initially helped Pettinger prepare for her procedure.
"Dennis is a wealth of information, which was especially helpful in the beginning," she said. "He answered my questions and sent background information to my other physicians. He was great. Dennis stills calls to this day to check in and follow-up."
Working with neurosurgeon Mark W. Jones, M.D., and radiation oncologist Rajesh Kotecha, M.D., Pettinger underwent a Gamma Knife procedure in April of 2016. She was able to have both the trigeminal nerve and the glossopharyngeal nerve treated the same day. The procedure does not require general anesthetic or an overnight stay in the hospital.
More than two years after Gamma Knife treatment, Pettinger's facial pain is gone and her throat pain is well controlled with fewer mediations.
Pettinger is aware that she may have to repeat the treatment in the future. "I hope I don't have to, but I would definitely do it again," she said. In the meantime, she continues to meet with her primary care physician on a regular basis and no longer needs to see a neurologist. She hopes that others who suffer like she did will continue to seek help. "Some people with trigeminal neuralgia pain go for years, and live with the pain without getting help," she said. "Gamma Knife treatment was wonderful and helped me immensely. I would recommend it to anyone."
Is Gamma Knife Right for You?
Let us review your case. Contact our Gamma Knife Coordinator for more information, or to arrange for a no-obligation review of your records and films by one of our neurosurgeons.
Gamma Knife® is a registered trademark of Elekta Group.