Trigeminal Neuralgia

Trigeminal neuralgia is a condition in which inflammation of the trigeminal nerve causes excruciating, sudden, or sporadic pain in the face. Episodes can vary in length, lasting only a few seconds or as long as two minutes. These episodes of pain can come in waves and can persist for an hour or more. The stabbing, knife-like pain has been likened to an electric shock on one side of the face.

The condition, which affects one in every 25,000 people, is caused by injury or damage to the trigeminal nerve, a sensory and motor nerve that originates in the brain and spreads, in three separate branches, to the cheeks, the jaw, and the area of the forehead and eyes. The trigeminal nerve delivers feeling to the face and allows facial movements to occur. Trigeminal neuralgia generally affects adults and is not uncommon in patients who suffer from multiple sclerosis. Most medical scientists believe it is caused by an abnormal vein or artery that compresses the trigeminal nerve.

Trigeminal neuralgia is also known as tic douloureux, because the pain can cause uncontrollable facial twitching. Learn More»

Diagnostic Testing and Treatment for Trigeminal Neuralgia

A patient who experiences an onset of unexplained facial pain typically visits his or her primary care physician or dentist. If a dental problem is ruled out, the patient should then be referred to a neurologist or neurosurgeon for further evaluation. A CT or MRI scan should be performed to rule out the possibility of multiple sclerosis or a tumor. A diagnosis is made after a careful assessment of the patient’s symptoms.

Medications

The first line of treatment for trigeminal neuralgia involves medication, including anticonvulsants, which block firing of the nerve, and muscle relaxants. Medications will provide a long-term solution for about 25 percent of patients with trigeminal neuralgia. Patients who do not achieve long-term pain relief from medications, or who develop unacceptable side effects, may become candidates for surgery.
 

Microvascular Decompression (MVD)

Microvascular decompression, or MVD, is a surgical procedure in which the surgeon makes an opening in the back of the skull and frees the nerve from the abnormality that is compressing it. The procedure is effective for 95 percent of patients and causes little or no facial numbness. Learn More

Percutaneous Stereotactic Radiofrequency Rhizotomy (PSR)

Percutaneous stereotactic radiofrequency rhizotomy, or PSR, is a minimally invasive procedure in which a hollow needle is inserted through the cheek and into the trigeminal nerve at the base of the skull. The neurosurgeon uses an electrode to destroy the portion of the trigeminal nerve that is causing pain. The procedure is immediately effective for 99 percent of patients. Symptoms will recur in about 15 percent of patients within 10 years. This subset of patients can be treated with medication, another PSR, or a different surgical procedure. Side effects include partial numbness in the area that was treated. Learn More

Percutaneous Glycerol Rhyzolysis

Percutaneous glycerol rhyzolysis is a minimally invasive procedure in which a hollow needle is inserted through the cheek and into the trigeminal nerve at the base of the skull. The neurosurgeon injects glycerol to damage the portion of the trigeminal nerve that is causing pain. The procedure is immediately effective in about 70 percent of patients, but symptoms will recur in 50 percent of patients in three to four years. Side effects include partial numbness in the area that was treated.

Percutaneous Balloon Compression

Percutaneous balloon compression is a minimally invasive procedure in which a hollow needle is inserted through the cheek and into the trigeminal nerve at the base of the skull. Using a narrow catheter, the neurosurgeon places a balloon inside the trigeminal nerve. Once inflated, the balloon compresses and damages the portion of the nerve that is causing pain. The balloon and catheter are then removed. The procedure is effective in about 80 percent of patients, but symptoms will recur in 20 percent of patients in three years. Side effects include minor numbness in the area that was treated.

Neurectomy

A neurectomy involves the cutting of the trigeminal nerve or one of its branches. A treatment of last resort, a neurectomy results is irreversible and results in permanent numbness of the region of the face that the nerve supplies. A neurectomy may be performed during an microvascular decompression if the neurosurgeon cannot find a vessel or other abnormality that is compressing the nerve.

Radiosurgery

Stereotactic radiosurgery is a noninvasive outpatient procedure in which precisely targeted beams of radiation are used to destroy a portion of the trigeminal nerve.