Trigeminal neuralgia is considered to be one of, if not the most, painful facial conditions a patient can endure. This disorder can be caused by the misfiring of nerve impulses from compression or damage to the trigeminal nerve. One of the most common symptoms that could indicate that you are suffering from trigeminal neuralgia can be a sharp, shock-like pain that begins to shoot up through your face, crossing a diagonal line from your mouth to above your ear.
Some common treatment options for bilateral trigeminal neuralgia include medical management, microvascular decompression, Gamma Knife radiosurgery, percutaneous rhizotomy and pain stimulator placement.
Treating Trigeminal Neuralgia
Despite the fact that trigeminal neuralgia has no known cure, there are many treatment options available to help ease or completely eliminate the pain and other symptoms that are associated with this condition. The success of each treatment option varies depending upon each patient’s individual health condition and overall wellness. The root cause of your trigeminal neuralgia can dictate which treatments may or may not be effective for you.
Medication
Some success in controlling the symptoms of trigeminal neuralgia has been found through the use of anticonvulsant medications such as Tegretol or Trileptal. Because medication is non-invasive, your neurologist will typically start with one of these medications to see if any relief can be obtained. Drugs such as opiates are not used, as they don’t really have an effect on the root cause of the pain and can be highly addictive.
Medication may prove successful in controlling the pain and discomfort of trigeminal neuralgia, but many times, the relief is short-lived. Generally, patients eventually require higher doses and still don’t see results, despite the increase. In other instances, it never truly provides relief, regardless of dosage. There is also the possibility that you may experience side effects that make it impossible to continue to use these drugs at all. Some side effects include confusion, dizziness, nausea and sluggishness.
Microvascular Decompression Surgery
Microvascular decompression is a very delicate and targeted surgical intervention that may provide relief to bilateral trigeminal neuralgia. When you elect to undergo microvascular decompression, your surgeon will explain that this surgery involves sedation through general anesthesia, which means that it may not be an option if you have another health condition that would not react well with the use of anesthesia. After you are sedated, a very small incision will be made behind your ear, revealing your trigeminal nerve and the blood vessel that is compressing it. The surgeon will then place a small Teflon sponge between the nerve and blood vessel. With the relief of compression, many patients no longer experience any pain.
Length of Procedure
Microvascular decompression surgery will typically take your surgeon anywhere from 1-3 hours to perform. In some instances, the place where the nerve is being compressed may be difficult to access. If this is the case, your procedure may take a little longer to perform.
Additional Information
Microvascular decompression is only advised if your bilateral trigeminal neuralgia is due to an impingement of your trigeminal nerve from an adjacent blood vessel. It will not be effective in cases where the trigeminal nerve is damaged through trauma or growth of a tumor. Your doctor will help you determine if you are a good candidate for this surgery.
Recovery
Unlike many other intracranial procedures, microvascular decompression has a comparatively short recovery time. You can expect full recovery and functionality within 8-12 months; however, many people who undergo microvascular decompression have resumed the majority of their normal activities by the third or fourth month following their procedure.
Gamma Knife Radiosurgery
Another option for patients who have bilateral trigeminal neuralgia is Gamma Knife Radiosurgery (GKRS). Gamma Knife Radiosurgery is considered the least invasive technique to treat trigeminal neuralgia. With this procedure, your doctor will aim several specifically targeted beams of ionizing radiation at the point in your head where your trigeminal pain initiates.
Similarly to microvascular decompression, your surgeon will immobilize your head within a head frame. This prevents any movement during the procedure. After placement, the exact target of the beams is identified through the use of CT or MRI scans. The beam is then programmed for the exact amount of radiation to be used and how long the beam will target the area. Patients who have experienced extremely high amounts of pain due to bilateral trigeminal neuralgia may experience relief after just one Gamma Knife Radiosurgery treatment or may need to undergo repeat treatments in order to reach the highest amount of pain eradication.
Length of Procedure
Gamma Knife Radiosurgery is unique in that it isn’t a particularly long procedure. You can expect the procedure itself to last anywhere from 1-2 hours. Preparation and post-procedure observation can be expected to last about the same amount of time. Depending on your surgeon, you may be asked to stay overnight in the hospital.
Additional Information
The effects of GKRS are seen gradually, because it focuses on damaging and destroying the offending tissue through exposure to therapeutic levels of radiation. You can expect to achieve full relief in several months, compared to the quicker relief seen with true surgical procedures such as microvascular decompression.
Recovery
Due to the fact that Gamma Knife Radiosurgery is completely noninvasive, you can expect the recovery time to be very short in comparison to other procedures. The majority of patients that undergo Gamma Knife surgery have resumed their normal activities in 24-72 hours. There are no restrictions in place following the procedure, aside from those that were already in place before undergoing Gamma Knife surgery.
Percutaneous Rhizotomy
Percutaneous rhizotomy is also a minimally invasive procedure that can bring pain relief to patients who have trigeminal neuralgia. With this procedure, you will likely be an outpatient. Percutaneous rhizotomy uses a specialized needle that is threaded into your head through your cheek and directs a special application of heat to destroy just a portion of the trigeminal nerve. This breaks the current that is causing your pain.
Your doctor may recommend percutaneous rhizotomy when other treatments or medications fail to manage your trigeminal neuralgia. You’ll need to undergo general anesthesia as a part of this procedure, so remember to discuss any other health conditions you have with your surgeon in order to determine if you are healthy enough to be fully sedated. In addition, you may experience slight numbness in your face after undergoing percutaneous rhizotomy. Often, this is far preferable to the intense and constant pain of trigeminal neuralgia.
Length of Procedure
Percutaneous rhizotomy takes around 1-2 hours to perform. You will be prepped for surgery and undergo full sedation, making the entire process last around four hours. An additional 4-6 hours post-procedure will allow you to come up out of sedation. You’ll be given an ice pack for the insertion site and encouraged to rest.
Additional Information
Percutaneous rhizotomy is a great option when you find other medications or options have failed. It affords you the opportunity to seek freedom from the pain and discomfort caused by your bilateral trigeminal neuralgia. Some individuals notice results right away, while others report its effects taking up to 4-6 weeks to reach satisfactory levels.
Recovery
Recovery from percutaneous rhizotomy is generally mundane. In most instances, you’ll be able to return home the same day as your procedure. Due to the numbness that will result from your procedure, you will be given a soft food diet to follow while you adjust to the new level of sensation. You can expect to need to do jaw exercises for a few weeks following your procedure to maintain and strengthen jaw muscles. You will also need to be vigilant with taking care of both your teeth and eyes.
Pain Stimulator Placement
Pain stimulator placement surgery is more invasive than some other types of treatment for bilateral trigeminal neuralgia. It is typically performed as a two-step process to test for possible results before undergoing the entire procedure. In the first step of pain stimulator placement, a temporary electrode is introduced to the trigeminal nerve. This electrode stimulates the nerve through the use of a weak current. This current is designed to confuse the pain center that is causing pain along the trigeminal nerve and interrupt that transmission.
During the trial phase, the temporary pain stimulator is attached to a power supply that you, as the patient, will have control over. You’ll be able to change some settings to find the ideal solution. If the trial phase is successful, the temporary electrode is replaced with a permanent one and attached to a power supply similar to those used by a pacemaker. Unlike other types of bilateral trigeminal nerve pain interventions, the placement of a pain stimulator is typically completed using only local anesthesia. You’ll likely be an outpatient and may be able to feel relief shortly after the temporary node is placed.
Length of Procedure
Pain stimulator placement takes approximately 1-3 hours. You will receive local anesthesia, meaning the area will be numbed, but you won’t be completely asleep. You can expect to stay in the hospital overnight to make sure everything is working as expected.
Additional Information
Pain stimulator placement doesn’t prevent the pain, but rather interrupts the signals that can cause the discomfort. Once you’ve finished your trial period and it’s deemed successful, a permanent neurostimulator will be placed underneath your skin.
Recovery
The recovery period for stimulator placement is fairly short. You’ll be able to go home the day after the initial placement. It’s wise to not partake in strenuous activities right away, as this can dislodge the newly placed stimulators.
Choosing the Right Neurosurgeon
Electing to undergo advanced treatment procedures to treat your bilateral trigeminal neuralgia can seem like an enormous and daunting decision to make. These treatments are typically only offered as a solution to patients for whom medication was ineffective or who have tried other surgical or enhanced procedures that did not result in relief.
Experience
It’s essential that your surgeon has a great deal of specific experience in treating bilateral trigeminal neuralgia. Your surgeon should be a licensed neurosurgeon who also specializes in treating facial conditions.
Skill
When you begin your search, look for a doctor with many successful bilateral trigeminal neuralgia surgeries and procedures under his or her belt. He or she will better understand the intricacies of dealing with bilateral trigeminal neuralgia in particular. He or she will also have the necessary skills to perform your procedure with very little risk of error.
Trust
Experience and skill on the part of your surgeon are only a fraction of the equation. Aside from being fully qualified, you should also always trust and feel comfortable with your neurosurgeon. A good relationship with any healthcare professional — from medical assistants to surgeons — should be built on a solid foundation of trust.
Communication
If you are not able to communicate freely with your doctor, you can’t expect to be able to ask the right questions. Choose someone who puts you at ease and is highly accessible. You should look for a doctor who is willing to take the time to answer all of your questions and treat you as an individual instead of a paycheck. You are, after all, entrusting your future health and well-being to your chosen surgeon.
Bilateral trigeminal neuralgia treatment can be confusing at first, but with the right information, you can make a decision that suits your needs and lifestyle. You deserve to live your life pain- and symptom-free.
