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Trigeminal Neuralgia

Medical Treatment

Trigeminal neuralgia is initially treated with medications.  Both anticonvulsant drugs and muscle relaxants have been used with success.  Side effects such as dizziness, drowsiness, confusion, nausea, and depression can limit their usefulness.  Trigeminal neuralgia sometimes follows a relapsing course, in which, patients will achieve pain control with medication and may even be able to be weaned off of the medication without recurrence of the pain.  In patients who cannot achieve pain control with medication more aggressive treatment is waranted

Surgery

Although some patients achieve adequate pain control through medication, many eventually stop responding to medication, or cannot tolerate the side effects.

For these patients, surgical intervention may provide significant pain relief. The surgical options fall into two categories.  Some of the surgical options for trigeminal neuralgia seek to either damage or destroy the part of the trigeminal nerve that is the source of the pain. Because the success of the procedure depends on damaging the nerve, one side effect is facial numbness of varying degrees. Alternatively, the source of the pain is pressure on the nerve from an artery and if the artery can be decompressed off of the never the pain will go away without damaging the nerve.

Nerve Damaging Procedures

Percutaneous Procedures

Many options for damaging the nerve via a needle inserted through the face, up past the jaw and into the hole at the base of the skull exist.  These include alcohol or glycerol injection, balloon compression, or electrical current (thermal rhizotomy).  An advantage of these procedures is relatively rapid results.  However, they tend to cause facial numbness and possibly weakness in the muscles used in chewing, and the pain relief has a tendency to fail with time.  The nature of the procedure also requires passing a large needle close to the carotid artery, and injury to this artery can cause a major stroke or death.

These are procedures that Dr. Pearson chooses not to perform.  He feels that the risk is greater with these procedures than with more effective measures.  The option is discussed with patients, and if this is your preferred method of treatment Dr. Pearson will be happy to refer you to a surgeon who does this.

Cyberknife Radiosurgery

The Cyberknife delivers an intense doses of radiation to the root of the trigeminal nerve.  This both causes damage to the nerve to eliminate the pain and probably causes vascular changed around the nerve to provide lasting relief. Cyberknife is painless and is typically done without anesthesia. This procedure is very low risk and is quite successful in eliminating the pain of trigeminal neuralgia. However, between three weeks and three months might be required for pain relief to begin.  Some patients have facial numbness after Cyberknife, and the pain can return or fail to respond.  Late effects of radiation are also a minor concern.  These can include, formation of radiation induce tumors, and radiation injury to the surrounding tissues (brainstem).

Nerve Sparing Procedure

Microvascular Decompression (MVD)

Trigeminal neuralgia happens when there is pressure from an artery on the trigeminal nerve.  The water-hammer effect of the pulse through the artery into the nerve causes irritation of the nerve  and results in the electric shock like pain of trigeminal neuralgia.

Microvascular decompression is a major surgical procedure performed in an operating room. The patient receives general anesthesia. A small incision is made behind the ear and, with the aid of a microscope, the trigeminal nerve is directly inspected through a small opening in the skull. The blood vessel or vessels that have contact with the trigeminal nerve root where it leaves the brain stem are moved away from the nerve. Protective pads are also placed between the vessel and the nerve to prevent recurrence of the pressure.  Microvascular decompression does not damage or destroy the trigeminal nerve.

 Pateinets typically spend two days in the hospital following microvascular decompression. Most patients have no facial numbness and are immediately relieved of the trigeminal neuralgia pain.  Medications are continued initially but can usually be stopped. The pain from surgery usually lasts about a week.

MVD has a high success rate but also carries risks, including a small chance of decreased hearing, facial weakness or numbness, double vision, and even stroke or death.