March 13, 2008, ST. LOUIS – J''Ack Haynes was the 2,000th patient to be treated with the Gamma Knife at Barnes-Jewish Hospital. She was somewhat unimpressed.

“Yes, they told me about it,” said Haynes, 84, of Seymour, Mo., when asked about her status as a milestone patient.

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But Haynes was indeed impressed that the 55 minute treatment she underwent on Feb. 13 would likely end three years of excruciating pain.

Haynes suffered from trigeminal neuralgia. In this condition the trigeminal nerve, which runs through the face and jaw, is compressed and results in sudden, intense, lancinating pain.

“Honey, having a baby is a joy compared to it,” Haynes said.

“Think root canal without anesthetic,” said Dr. Joshua Dowling, the Washington University neurosurgeon treating Haynes. “The pain can be pretty debilitating.”

Most patients with the condition are helped by medication. Those who aren''t may opt for microvascular decompression in an open surgical procedure or a minimally invasive “needle” procedure, said Dr. Dowling.

However, these procedures can be risky for elderly patients who, like Haynes, have other health problems. For these patients, the Gamma Knife provides an effective, safe treatment.

With Gamma Knife surgery, radiation replaces the scalpel and focuses 201 beams of radiation tightly on a target in the head while causing minimal damage to surrounding tissue.

Gamma Knife surgery can help a variety of problems originating in the head, including acoustic tumors, some movement disorders and blood vessel malformations, as well as trigeminal neuralgia. In conjunction with the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University, the Gamma Knife is used to treat primary and metastatic brain tumors.

The Gamma Knife Center at Barnes-Jewish opened in 1998 and is a community resource, according to operations manager Eric Filiput, RN. A consortium of area hospitals treats patient with the device.

Other patients throughout the Midwest, such as Mrs. Haynes, are referred for treatment to Washington University physicians at Barnes-Jewish, he said.

Mrs. Haynes'' problems began about three years ago, when what started as a tingling sensation in her jaw turned into a sharp pain. Both she and her dentist attributed the pain to a bad tooth. She had the tooth extracted.

But the pain worsened and soon was triggered by Mrs. Haynes talking, eating or brushing her teeth. Eventually, even a breeze on her cheek resulted in agony.

“There''s nothing to describe that pain,” she said.

After a Springfield, MO, neurologist diagnosed trigeminal neuralgia, Mrs. Haynes started on medication. When medication failed to control the condition, Springfield neurosurgeon Salim Rahman, MD, referred her to Dr. Dowling, who determined that Mrs. Haynes was a good candidate for Gamma Knife treatment.

“Hopefully, she''ll get pain relief,” he said. “The Gamma Knife is a good option because it''s relatively easy on the patient.”

The actual treatment is a three-step process. First, the patient is fitted with a metal head frame to immobilize her head during treatment. Second, the patient has MRI and CT scans, and sometimes cerebral angiograms, to map her anatomy and pinpoint the radiation target. The last step is the treatment.

“I look like I''m going into space,” she said after seeing herself in a mirror with the headframe on.

Nurses Karen Watts, RN, and Chris Bosseng, RN, positioned Mrs. Haynes on the treatment table. Then Filiput and Dr. Dowling, along with Watts and Bosseng gently fixed the headframe into a helmet within the device. The staff then went to the adjacent control room to monitor the procedure.

For the next 55 minutes, radiation bombarded Mrs. Haynes trigeminal nerve at a point just before it enters the brain near the brain stem. Changes to the nerve from the radiation should, over time, make it less sensitive to pain triggers.

The treatment itself is painless, with patients sometimes dozing off.

Mrs. Haynes will return for a follow-up visit in about six weeks. The Gamma Knife Center has treated more than 330 trigeminal neuralgia patients. And Mrs. Haynes, like most of the other patients should eventually be pain-free.

The device is a valuable tool in treating an average of 200 patients each year for a variety of disorders and diseases, Dr. Dowling said.

“The Gamma Knife is a godsend around here,” Dr. Dowling said. “It can be used to treat so many things. We can tailor the treatment to fit the specific patient, and we can treat patients who have other health issues. I''ve even used it to treat a woman with trigeminal neuralgia who was 100.