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» Directors Greeting
                                                                                            ON TARGET
                                                                                              G A M M A K N I F E C E N T E R Q U A R T E R LY N E W S L E T T E R
                                                                                              OF THE PACIFIC

» Trigeminal Neuralgia
                                    » Factoid:
» Our First Patient                 As of December 2003 there                            Trigeminal Neuralgia
                                    were 193 Gamma Knife Units                                              Trigeminal neuralgia was one of the first conditions
» Dr. Leon K. Liem                  installed worldwide. Here is                                            successfully treated by the Gamma Knife. Initially the
                                    the breakdown:                                                          treatment target was the gasserian ganglion, however
» Factoid                               North America: 86                            Trigeminal Neuralgia   with the advancement of MRI and CT the treatment
                                                                    (TN - tic douloureaux) is a disorder
                                             Japan: 41                                                      target is now the trigeminal root entry zone. The success
                                                                   of the fifth cranial nerve with clinical
                                             China: 15                                                      rate has been very high and Gamma Knife SRS is now
                                                                              features of; sharp stabbing
                                          Other Asia: 19             paroxysms of pain, usually on one      the leading form of non-medical treatment.
                                                                     side of the face with trigger points               Trigeminal Neuralgia (TN – tic douloureaux) is
                                           Europe: 26
                                                                                                                        a disorder of the fifth cranial nerve with clinical
                                          Middle East: 4
                                                                                                                          features of; sharp stabbing paroxysms of
                                         Latin America: 2
                                                                                                                            pain, usually on one side of the face with
                                                                                                                             trigger points, in a distribution limited to
                                                                                                                            the trigeminal nerve. The sensory division
                                    Neurosurgeons:                                                                       of the nerve distributes these recurrent painful
                                    Maurice Nicholson M.D.                                                             attacks through the branches leading from the
                                    Leon Liem M.D.                                                                     face, and is typically felt on one side of the jaw,
Gamma Knife Center of the Pacific
   2226 Liliha St., Level B1        Eric Oshiro M.D.                                                                  cheek, gums or forehead. Although rare, the
   Honolulu, HI 96817               Warren Ishida M.D.                                                              pain can be bilateral. Facial pain may result from
   Tel: 808 535-1579                Gonzalo Chong M.D.                                                           compression or irritation of the trigeminal nerve by a
   Facsimile: 808 535-1540          Jon Graham M.D.                                      loop of artery or vein, a tumor beside the nerve, or de-myelinizing plaque.
   Toll Free: 1 888 426-6215        Dan Donovan M.D.                                     Possible contributing factors include sinus, jaw or teeth infections, trau-
                                    Raymond Taniguchi M.D.                               ma, or degeneration of the gasserian ganglion.
Visit us at our website:            Alfred Bowles M.D.                                         TN affects approximately 1 in 10,000 persons and, although not            Michon Morita M.D.                                   fatal, it may severely incapacitate the patient’s lifestyle. TN occurs more
                                                                                         commonly in women, particularly the 50 and over age group, but no
                                    Radiation Oncologists:                               one is immune.
                                    Paul DeMare M.D.                                           Trigeminal Neuralgia may be controlled by a variety of pharmacological
                                    Thanh Huynh M.D.                                     agents or invasive procedures such as; anticonvulsant medications
                                    Laeton Pang M.D.                                     (including Dilantin, Tegretol, and Trileptal), glycerol rhizotomy,
                                    Winlove Suasin M.D.                                  radiofrequency rhizotomy, balloon compression, microvascular decom-
                                    Christina Liu M.D.                                   pression, or Gamma Knife SRS.                                        Continued
“Success rates for the treatment                                                       Continued from cover story

    of trigeminal neuralgia
  with GammaKnife SRS have                                                             Trigeminal Neuralgia
      been 80-90 percent”
                                                                                       Overall success rates for Gamma Knife SRS have been 80-90 percent, with
                                          Aloha!                                       only 10 percent having recurrent pain after three years with the option to
                                          We recently celebrated our 500th patient     repeat Gamma Knife treatment. At the Gamma Knife Center of the Pacific
                                          treated at the Gamma Knife Center of         we have successfully treated over 100 cases of TN and results of a survey
 Physician Highlight                      the Pacific, however, I remember very        conducted show that 80% of these patients had partial or complete relief
                                                                                       from their pain. When asked in the survey if they would recommend
                      Dr. Leon K.         well our first patient who is mentioned
                                                                                       Gamma Knife surgery to other patients for treatment of Trigeminal
                                          elsewhere in this newsletter. I remem-
                      Liem earned his     ber how happy she was that she did not
                                                                                       Neuralgia only two respondents said they would not.
                                                                                             The success and exponential growth in the use of the Gamma Knife
                      medical degree      have to undergo a craniotomy and
                                                                                       for treatment of trigeminal neuralgia has made it the preferred minimally
                      from Albert         could be treated on the gamma knife.
                                                                                       invasive treatment by physicians and patients here in Hawaii and the Pacific.
                                          She has remained one of our most
                      Einstein College    enthusiastic supporters over the years.
                      of Medicine in
                                          Elsewhere in this newsletter is an article
                                                                                       Our First Patient
                      the Bronx, New
                                          on trigeminal neuralgia and it has been      On December 1, 1998 Vera, a lovely
 York. He completed his internship        very gratifying over the years to see        70 year old woman was treated for an
 in general surgery at the University     many patients relieved of their severe       acoustic neuroma which had produced
                                          facial pain. Many of these patients have     symptoms of dizziness and dysesthesia into
 of Maryland Medical Systems,
                                          been very elderly and were at too high a     the right face. She had been very afraid of
 his rotation in the Neurosurgery         risk to undergo surgery, which is the        having surgery performed because of the
 Department at the Barrow                 other treatment alternative. Fortunately,    potential complications, including that of a
                                          age is not a problem for treatment with      right facial paralysis. She was very happy that
 Neurological Institute in Phoenix,       the gamma knife.                             the gamma knife treatment was available for
 Arizona, and his residency training                                                   her, and post operatively she was very grateful
 also at University of Maryland. He is    We at the Gamma Knife Center would           and happy for having had treatment at our center.
                                          like to thank, once again, all of our               On December 11, 2000 we received a letter in which she made
 Board Certified by the National          supporting physicians and patients who       the following statement; “Thanks again for your wonderful care and
 Board of Medical Examiners and the       have made this center a success.             for the gamma knife machine. I hope more people take advantage of
 American Board of Neurological                                                        it, it’s a ‘Godsend’.” Vera has since moved to the mainland to take
 Surgery. Dr. Liem’s clinical interests                                                care of her older sister. She again wrote the Gamma Knife Center
                                                                                       of the Pacific on Septmeber 23, 2002 stating she was doing very well;
 are in complex spine surgery, Gamma                                                   “I will always remember the great care I received on that day,
 Knife Radiosurgery, endoscopic                                                        December 1, 1998. You and your staff have a happy holiday season
 spine & cranial surgery, cerebrovas-                                                  that will soon be upon us”.
                                          Maurice W. Nicholson, M.D.
 cular surgery and pain neurosurgery.     Medical Director