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Functional neurosurgery in Tijuana
Surgery that does not remove a lesion but corrects a function: trigeminal neuralgia, hemifacial spasm, spasticity and epilepsy that does not respond to medication.
When the problem is the function, not the lump
In most of neurosurgery there is something to remove: a tumour, a clot, a disc fragment. In functional neurosurgery the imaging is often normal and what fails is how a circuit works. The classic example is trigeminal neuralgia: bursts of electric pain across half the face, triggered by speaking, chewing or brushing teeth, on an MRI that looks healthy.
The origin is usually a blood vessel touching the nerve root and wearing away its insulation. Treatment always begins with medication — carbamazepine and similar — and only when that stops working or is not tolerated does the operating room come into the conversation.
The surgical options, and who each is for
Microvascular decompression separates the vessel from the nerve with a small insulating material. It is the only technique that corrects the cause and offers the most durable relief, but it requires a retrosigmoid craniotomy and a patient in good general condition. Percutaneous techniques — balloon, radiofrequency or glycerol rhizotomy — enter through the cheek, without opening the skull, and are the better option in older or higher-risk patients.
The same principle of vascular compression explains hemifacial spasm, with involuntary contractions on one side of the face, treated along analogous lines. In drug-resistant epilepsy, surgical assessment is always made jointly with neurology: video EEG, targeted MRI and study of the focus before anything is proposed.
What the procedure involves
When it is indicated
- Trigeminal neuralgia resistant to or intolerant of medical treatment
- Hemifacial spasm from neurovascular compression
- Recurrent facial pain after a previous procedure
- Drug-resistant focal epilepsy under multidisciplinary assessment
- Severe spasticity limiting hygiene and mobility
- Glossopharyngeal neuralgia
Techniques and resources
- Operating microscope
- High-resolution posterior fossa MRI
- Cranial nerve monitoring
- Radiofrequency equipment
- Balloon for percutaneous rhizotomy
- Video EEG
Frequently asked questions about functional neurosurgery
The picture suggests trigeminal neuralgia, especially if the pain lasts seconds, is lancinating and is triggered by speaking, chewing, cold or touching the face. Many patients undergo several unnecessary dental treatments first. A neurosurgical assessment is worthwhile.
It is the option with the most durable relief because it treats the cause, but no technique guarantees the pain will not return. Percutaneous techniques relieve more immediately and with less surgical risk, though with a higher recurrence rate and associated facial numbness.
Only some patients are candidates: those with focal seizures uncontrolled by two or more properly chosen drugs, in whom a resectable focus can be identified. The assessment is long and always made together with neurology.
Bring your imaging and settle the question
One consultation with your MRI or CT in hand is worth more than ten internet searches. Book by phone or through the form and you will be told what is there, what it means and what your options are.