Living with trigeminal neuralgia can be difficult. Disruptions in the function of the trigeminal nerve cause intense pain that can be incredibly debilitating not only because of the pain itself, but also because of the unpredictability of the attacks. Although there is no cure, medications like anticonvulsants and antidepressants have demonstrated some efficacy in relieving pain.
For those who are unsatisfied with the medication they have received, several surgical techniques have emerged in recent years as attractive options. It is important to discuss your treatment options with a facial pain specialist, but should you decide on surgery, here are four of the most promising methods in use today.
Microvascular Decompression
The concept behind microvascular decompression is that a blood vessel is compressing the nerve, disrupting its protective coating and causing pain. To address this, the surgeon makes an incision behind the ear and exposes the trigeminal nerve. Then, while viewing it under magnification, the surgeon moves the adjacent blood vessel and places a teflon cushion between it and the nerve, thereby relieving unwanted pulsations and allowing the nerve’s protective coating to heal.
This is an inpatient operation because the patient will likely need to recuperate in the hospital for a few days post-surgery. Despite its invasiveness, microvascular decompression offers the lowest rate of pain recurrence of all procedures mentioned, with most patients experiencing relief for more than 10 years. Many patients living with trigeminal neuralgia have found that this permanently relieved their symptoms.
Gamma Knife Radiosurgery
Gamma Knife Radiosurgery, also known as stereotactic radiosurgery, involves directing several concentrated beams of radiation toward the trigeminal nerve. This produces a lesion, which can relieve pain by reducing the nerve’s activity. Even though the process is referred to as surgery and results in a small lesion, it involves no incisions. Rather, it was named as such because of its similarity to the outcome of surgery; its precision can target the trigeminal nerve, preserve healthy surrounding tissue and relieve pain with one treatment.
Gamma Knife Radiosurgery is a common choice for patients living with trigeminal neuralgia living with trigeminal neuralgia because it is not invasive, it involves minimal pain or discomfort and it has a relatively strong rate of success, with significant pain control or reduction in more than 80 percent of patients.
Percutaneous Rhizotomy
Percutaneous rhizotomy is an outpatient procedure that is similar to Gamma Knife Radiosurgery in that it creates a small lesion on the trigeminal nerve to reduce the transduction of pain signals. Living with trigeminal neuralgia is often a significantly lighter burden when the affected nerve isn’t firing at full capacity, and therefore lesioning it is a priority among many doctors. Surgeons carry out the operation by three common means: balloon compression, glycerol injection and radiofrequency lesioning.
Balloon compression is performed under general anesthesia and involves inserting a tube through the cheek and directing it toward the trigeminal nerve. A deflated balloon is passed through the tube until it reaches the nerve, at which point it is inflated, thus pressing the nerve and damaging it from the pressure against the bone. After a minute or so of inflation, the balloon is deflated and removed.
During a glycerol injection, the surgeon inserts a needle through the cheek and guides it to the nerve while the patient is under sedation. The injection surrounds the nerve with glycerol and wears away the protective coating to reduce its activity.
The third common type of percutaneous rhizotomy is radiofrequency lesioning, in which the surgeon passes a needle through the skin toward the nerve, just as in the other procedures. The patient is briefly awoken from anesthesia to offer feedback to direct the surgeon toward the location of the pain. Once the surgeon finds the target area of the nerve, the patient is anesthetized once more, and the surgeon lesions the area with a heated needle. All three types of percutaneous rhizotomy are likely to offer pain relief for two to four years following surgery.
Pain Stimulator Placement
The goal of pain stimulator placement is to alter the activity pattern of the trigeminal nerve with the use of an electrical stimulator. In this operation, the patient is given a local anesthetic, and the surgeon places a small electrode under the skin. The surgeon then uses a CAT scan to direct the electrode to the nerve, at which point the electrode is connected to an external stimulator to provide the current. Once the patient reports feeling burning, itching or tingling, the stimulator is implanted temporarily.
The patient is instructed to monitor the pain for a trial period after surgery; if the patient finds the stimulation lessens the pain and allows for a reduction in medication, then the surgeon implants the stimulator permanently. Recurrence of pain after the surgery can be easy to manage; it may simply require the adjustment of the stimulator.
Closing Thoughts
Living with trigeminal neuralgia is often a complicated challenge, so it’s important that sufferers seek professional guidance as to which course of treatment is best for their situation. Patients should use this overview of the most common surgical procedures to treat trigeminal neuralgia to help formulate questions and discuss options with their doctors.
