Dr. Thomas Waltz 585-455-9100
RECAP OF FEBRUARY 5, 2005 MEETING
By Kay Holiday
Our speaker was Dr. Thomas Waltz, Neurosurgeon at Scripps Hospital, 10666 North Torrey Pines Road, La Jolla, CA
92037 and his phone number is 858-455-9100.
First Dr. Waltz passed around a picture of a recent microvascular decompression surgery he had done which clearly
showed the blood vessel that was up against the 5th (cranial) nerve. Dr. Waltz is also known as the Wizard of the
Needle because of his many successful Glycerol Injections. When a patient comes to see him and he realizes from
the history that they have true Trigeminal Neuralgia, he smiles because he knows that one way or another he is
going to be able to keep them out of pain for the rest of their lives.
The correct diagnosis all hinges on a good history of the pain. When it started, what type of pain was it: dull aching
or lightening, sharp electrical pain that came or went quickly. If the latter, he knows he can help but the patients
with the dull aching pain are more difficult to treat. True TN has trigger points that can set off the pain when eating,
talking, brushing teeth, laughing etc.
He stressed how important it is to start a notebook to write down each time an attack of pain occurs, what you
were doing, where you were, and describe the pain.
He needs to know if the pain went into remission and for how long. Have you had any dental work done and any
local anesthesia used by the dentist; what was the effect of any medications you have been on; why did you
change medications, what side effects did you have to medications and did they bother you severely. Have you had
any facial injury, been in an accident or had a diagnosis of Multiple Sclerosis.
Because medications affect your memory of the pain, it is important for you to remember the very first time the pain
hit and what it was like and what you did. The medication may have changed a sharp electrical pain to a dull ache
which would affect the diagnosis and what procedure would be selected to stop the pain.
The treatments available to treat true Trigeminal neuralgia are highly successful and usually he can relieve true TN
pain for a lifetime. He may have to repeat some of the procedures as the success time varies greatly between
patients but one way or another he can he feels he can take the pain away.
Unfortunately, the dull burning pain of atypical facial pain is not so easily treated and he can’t promise success even
for a short time. This includes pain after trauma to the face from dental work or an accident. But it is still worth
seeing a neurosurgeon even if you have atypical facial pain. Dr. Waltz says he has rarely seen a patient with pain
on both sides of the face who has typical TN. The pain is always on one side but it might hit the other side at a
different time. It is more common in the cheek and nose, upper and lower teeth than in the forehead. He has seen
thousands of patients and only 10 have had it on both sides and never at the same time.
He also talked about the Glossopharangeal Neuralgia which affects the 9th nerve which causes pain to the tonsils,
the back of the tongue and it is very difficult to surgically reach the 9th nerve. Another form is neuralgia are Cluster
Headaches or Migraine Headaches and a glycerol injection sometimes helps them.
He says a nerve is composed of thousands of extremely tiny fibers (think of a telephone wire). If the fibers are
touched by the loop of a blood vessel or lose insulation, you get what he calls "an epileptic seizure in the nerve"
and the fibers become sensitive and you have pain.
He feels that Tegretol is the gold standard of all the drugs to treat TN and the others don’t really help too much. He
thinks Neurontin has been over sold by Drug salesmen. He often sees patients that have been overdosed on
Tegretol and they lose their balance or are constantly sleepy. He suggests instead of 3 tablets a day that you
break them in half and take them 6 times a day to even out the side effects. When the side effects become
intolerable, it is time to consider surgery. The microvascular decompression is the only surgery that gets to the root
of the problem.
From 1972 to 1982 he would do a Radiofrequency where he would insert a needle and heat the tip to 65c which
would cause physical trauma to the nerve and interfere with the pain and it was very effective but is no longer
done on the West Coast but is popular on the East Coast still.
He found that the Glycerol injection was more controllable and no Anesthesia Dolorosa ( numbness but still pain).
Dr. Waltz thinks the Gamma Knife is equal to the Glycerol but kicks in more slowly and you remain in pain longer.
With the MVD and the Glycerol injection you usually are out of pain immediately. If you have the Gamma Knife and
the pain continues to be severe, a glycerol injection is often done to ease the pain until the Gamma Knife kicks in
which makes two surgeries instead of one.
The glycerol injection has 85 to 90% success rate and is an outpatient procedure with very little risk and good
patient acceptability. There may be some numbness but is usually leaves within weeks. The recurrence rate is 20-
30% over 2-4 years although we have one man who had one 13 years ago and is still out of pain. Several in the
Group had their Glycerol injections last about 6 years and then had it repeated.
The Microvascular Decompression also has 85-90% success rate with little numbness and a low recurrence rate. It
is major craniotomy surgery but with a low incidence of complications.
During question time Jack is having problems with sharp pain waking him up when he is sleeping. He sleeps sitting
up but apparently something touches the face and sets the pain off.
Anna Maria says she has a dull ache around her mouth and they think it might be NICO and she is thinking of
having the bone cleaned out. She has done a lot of research on this which she has sent to me. Dr. Waltz doesn’t
think she has Trigeminal neuralgia. Valerie is not in severe pain now but wonders if she should have the surgery
before the pain gets worse. Dr. Waltz answered when the pain gets severe enough that you decide to have a
surgery, why stay in pain, just go ahead and do it.
Don G. is stressed because he has to have dental work done. DR. Waltz says most dentists never see a case of
Trigeminal neuralgia but Don should increase medication, and tell dentist to use a lot of local anesthetic on the
gums and careful placement of needle. He thinks the stimulation in dental work may have something to do with
setting off pain that was about to happen anyway.
Which surgery first depends on your age and general health. If you are young and in good health have the MVD. If
85 and above have a glycerol injection and in-between ages it is up to the patient.
He says the MVD is more challenging for him to do so he enjoys it more but he has had some spectacular successes
doing the Glycerol Injection.
We all thanked Dr. Waltz for coming to speak to us.
Return to Home Page
By Kay Holiday
Our speaker was Dr. Thomas Waltz, Neurosurgeon at Scripps Hospital, 10666 North Torrey Pines Road, La Jolla, CA
92037 and his phone number is 858-455-9100.
First Dr. Waltz passed around a picture of a recent microvascular decompression surgery he had done which clearly
showed the blood vessel that was up against the 5th (cranial) nerve. Dr. Waltz is also known as the Wizard of the
Needle because of his many successful Glycerol Injections. When a patient comes to see him and he realizes from
the history that they have true Trigeminal Neuralgia, he smiles because he knows that one way or another he is
going to be able to keep them out of pain for the rest of their lives.
The correct diagnosis all hinges on a good history of the pain. When it started, what type of pain was it: dull aching
or lightening, sharp electrical pain that came or went quickly. If the latter, he knows he can help but the patients
with the dull aching pain are more difficult to treat. True TN has trigger points that can set off the pain when eating,
talking, brushing teeth, laughing etc.
He stressed how important it is to start a notebook to write down each time an attack of pain occurs, what you
were doing, where you were, and describe the pain.
He needs to know if the pain went into remission and for how long. Have you had any dental work done and any
local anesthesia used by the dentist; what was the effect of any medications you have been on; why did you
change medications, what side effects did you have to medications and did they bother you severely. Have you had
any facial injury, been in an accident or had a diagnosis of Multiple Sclerosis.
Because medications affect your memory of the pain, it is important for you to remember the very first time the pain
hit and what it was like and what you did. The medication may have changed a sharp electrical pain to a dull ache
which would affect the diagnosis and what procedure would be selected to stop the pain.
The treatments available to treat true Trigeminal neuralgia are highly successful and usually he can relieve true TN
pain for a lifetime. He may have to repeat some of the procedures as the success time varies greatly between
patients but one way or another he can he feels he can take the pain away.
Unfortunately, the dull burning pain of atypical facial pain is not so easily treated and he can’t promise success even
for a short time. This includes pain after trauma to the face from dental work or an accident. But it is still worth
seeing a neurosurgeon even if you have atypical facial pain. Dr. Waltz says he has rarely seen a patient with pain
on both sides of the face who has typical TN. The pain is always on one side but it might hit the other side at a
different time. It is more common in the cheek and nose, upper and lower teeth than in the forehead. He has seen
thousands of patients and only 10 have had it on both sides and never at the same time.
He also talked about the Glossopharangeal Neuralgia which affects the 9th nerve which causes pain to the tonsils,
the back of the tongue and it is very difficult to surgically reach the 9th nerve. Another form is neuralgia are Cluster
Headaches or Migraine Headaches and a glycerol injection sometimes helps them.
He says a nerve is composed of thousands of extremely tiny fibers (think of a telephone wire). If the fibers are
touched by the loop of a blood vessel or lose insulation, you get what he calls "an epileptic seizure in the nerve"
and the fibers become sensitive and you have pain.
He feels that Tegretol is the gold standard of all the drugs to treat TN and the others don’t really help too much. He
thinks Neurontin has been over sold by Drug salesmen. He often sees patients that have been overdosed on
Tegretol and they lose their balance or are constantly sleepy. He suggests instead of 3 tablets a day that you
break them in half and take them 6 times a day to even out the side effects. When the side effects become
intolerable, it is time to consider surgery. The microvascular decompression is the only surgery that gets to the root
of the problem.
From 1972 to 1982 he would do a Radiofrequency where he would insert a needle and heat the tip to 65c which
would cause physical trauma to the nerve and interfere with the pain and it was very effective but is no longer
done on the West Coast but is popular on the East Coast still.
He found that the Glycerol injection was more controllable and no Anesthesia Dolorosa ( numbness but still pain).
Dr. Waltz thinks the Gamma Knife is equal to the Glycerol but kicks in more slowly and you remain in pain longer.
With the MVD and the Glycerol injection you usually are out of pain immediately. If you have the Gamma Knife and
the pain continues to be severe, a glycerol injection is often done to ease the pain until the Gamma Knife kicks in
which makes two surgeries instead of one.
The glycerol injection has 85 to 90% success rate and is an outpatient procedure with very little risk and good
patient acceptability. There may be some numbness but is usually leaves within weeks. The recurrence rate is 20-
30% over 2-4 years although we have one man who had one 13 years ago and is still out of pain. Several in the
Group had their Glycerol injections last about 6 years and then had it repeated.
The Microvascular Decompression also has 85-90% success rate with little numbness and a low recurrence rate. It
is major craniotomy surgery but with a low incidence of complications.
During question time Jack is having problems with sharp pain waking him up when he is sleeping. He sleeps sitting
up but apparently something touches the face and sets the pain off.
Anna Maria says she has a dull ache around her mouth and they think it might be NICO and she is thinking of
having the bone cleaned out. She has done a lot of research on this which she has sent to me. Dr. Waltz doesn’t
think she has Trigeminal neuralgia. Valerie is not in severe pain now but wonders if she should have the surgery
before the pain gets worse. Dr. Waltz answered when the pain gets severe enough that you decide to have a
surgery, why stay in pain, just go ahead and do it.
Don G. is stressed because he has to have dental work done. DR. Waltz says most dentists never see a case of
Trigeminal neuralgia but Don should increase medication, and tell dentist to use a lot of local anesthetic on the
gums and careful placement of needle. He thinks the stimulation in dental work may have something to do with
setting off pain that was about to happen anyway.
Which surgery first depends on your age and general health. If you are young and in good health have the MVD. If
85 and above have a glycerol injection and in-between ages it is up to the patient.
He says the MVD is more challenging for him to do so he enjoys it more but he has had some spectacular successes
doing the Glycerol Injection.
We all thanked Dr. Waltz for coming to speak to us.
Return to Home Page
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