First Coast Neurosurgery cares about finding the most effective and comfortable solutions to treat your pain. Our expert board-certified neurosurgeons, Dr. Michael Horowtiz and Dr. Cheslovas Rothschild, have specialized training neurosurgical care for patients in Orange Park and the surrounding communities.

Neurosurgical conditions treated:

  • Aneurysms
  • Brain Tumors
  • Brain Surgery
  • Carotid Stenosis
  • Cerebral Hemorrhage
  • Glossopharyngeal Neuralgia
  • Hemifacial Spasm
  • Hydrocephalus
  • Nose Bleeds
  • Occipital Neuralgia
  • Stroke
  • Traumatic Brain Injury
  • Trigeminal Neuralgia
  • Vascular Malformations

Cranial Nerve Disorders:

Trigeminal neuralgia

(TN; tic douloureux) is a chronic pain condition that arises from the trigeminal nerve, which carries sensation from the face, ear canal, dural covering of the brain, blood vessels of the brain, and cornea to your brain. When patients suffer from trigeminal neuralgia, even mild stimulation of the face such as a cool breeze, chewing food, air conditioning, brushing of teeth, light touch, etc. may cause sudden excruciating, electrical shock like pain on one side of the face. Pain may also arise suddenly without warning or provocation.

The exact cause for TN is unknown. Many cases, however, seem to be due to arteries or veins that rest on the surface of the nerve and which damage the nerve by beating on it with each heartbeat. While relief may be achieved through the use of certain medications, many patients either do not respond to the medications or have intolerable side effects. For these individuals, a surgical procedure (Microvascular Decompression; MVD) that moves the blood vessels away from the nerve is often highly effective at immediately and permanently eliminating the symptoms.

Geniculate Neuralgia

(GN) is a rare condition that is caused by a small nerve being compressed by a blood vessel. This nerve normally provides sensation to the ear canal and ear drum, but when it functions abnormally it can cause sudden severe sharp, deep ear pain. Geniculate Neuralgia must be differentiated from other causes of deep ear pain such as that caused by post herpetic and bacterial infections. Surgical treatment is Microvascular Decompression and involves identifying and cutting the fascicles of the nervus intermedius as they travel between the nerve that moves the face and the hearing nerve so that the nerve no longer functions. This procedure carries a greater than 90% chance of immediate, long-, permanent pain relief.

Glossopharyngeal Neuralgia

(GPN) is characterized by a unilateral severe, sharp, jabbing pain in the posterior tongue, ear, and tonsils, lasting a few seconds to a few minutes. This pain is generally brought on by swallowing liquids (especially cold liquid) or solids and is felt to be due to compression of Glossopharyngeal and Vagus Nerves as they exit the brainstem by arteries and/or veins. Relief of pain can be achieved through a surgical procedure Microvascular Decompression that moves the arteries and veins away from the nerves so that they are not irritated with each heart-beat. Surgery also usually involves decompression of the Trigeminal Nerve and at times sectioning of the Nervus Intermedius in order to eliminate all sources of potential irritation.

Hemifacial Spasm

(HFS) is a condition in which an eye, face and/or neck suddenly twitch uncontrollably causing the eye to close tightly and the corner of the mouth and neck to rise up due to muscle contraction that can last several seconds. While the syndrome is not painful it can be extremely debilitating and over time can lead to a weakened face and a facial droop. The cause for this condition is the Facial Nerve being compressed by arteries and veins as it exits the brainstem. Each heartbeat leads to the nerve being struck by the blood vessel which damages the nerve and causes it to fire erratically. Veins lying on the nerve can also contribute to the symptoms. Treatment involves a surgical procedure (Microvascular Decompression; MVD) that moves the arteries and veins away from the nerve so that it can function normally. Patients usually awake from surgery spasm free.

Occipital Neuralgia

(ON) is by definition not a disorder of the cranial nerves but rather of the Occipital Nerve which arises from the first 3-4 dorsal nerve rootlets of the spinal cord. This syndrome leads to severe shooting pain on one side of the back of the head. While it can occur spontaneously, it may also result from trauma to the back of the head or neck. Several treatment options are available for this condition that include physical therapy, massage, acupuncture, steroid injections and surgical sectioning of the nerve itself to numb the scalp.