Trigeminal neuralgia sufferers experience brief, intense episodes of severe facial pain, usually described as electric shocks or stabbing pains, around the trigeminal nerve. This nerve supplies sensation from the forehead down to the chin. Typically, patients experience the pain on one side of the face, but it can spread to the other side as well.
Usually, an artery or a vein pinches the trigeminal nerve inside the brain, causing the trigeminal neuralgia pain. Other causes include multiple sclerosis and, much less common, a tumor. There are also times when we cannot determine the cause. An MRI or CT scan will aid in trigeminal neuralgia diagnosis.
Trigeminal neuralgia pain relief is quite likely with the use of anti-seizure medications such as Neurontin, Lyrica, Trileptal, or Tegretol. However, when patients do not respond well to medication, we consider the following procedures.
Procedure A: Moving the Blood Vessel Away From the Nerve.
This operation is performed under general anesthesia and takes about two hours. First, we make a small incision behind the ear and remove a little piece of bone. Using a microscope, we move the blood vessel away from the nerve and insert a small sponge between the blood vessel and nerve.
This operation does have some risk, although it’s very, very small. It typically has the benefit of working right away, with the best chance of being curative. It is best for young, otherwise healthy people who do not have multiple sclerosis.
Procedure B: Nerve Injury/Nerve Block
There are two methods of performing the nerve block. Both methods are performed under sedation on an out-patient basis. These procedures carry less overall risk and are best for older people, as well as those with significant medical conditions such as multiple sclerosis. There is, however, some chance of new numbness and facial aches from over-injury of the nerve, and the trigeminal neuralgia pain may recur if the nerve regrows.
One nerve injury option, called a Rhizotomy, involves inserting a needle into the cheek and threading the needle up into the nerve. Then, we may heat the nerve, inject it with alcohol, or inflate a balloon against the nerve before withdrawing the needle. This procedure usually works right away.
Another option involves super-focus radiation or stereotactic surgery using a machine. This procedure often takes several weeks to work.
In summary, trigeminal neuralgia is a very painful condition. However, we have good treatments for it, and if one treatment does not work, often, another one will.