Trigeminal neuralgia is considered to be one of the worst types of pain a person can experience. Unfortunately, it can also be one of the hardest for a practitioner to treat — modalities and medications that work on one patient may not have a positive impact on another.
Although you, as a patient, will want to explore every possible alternative to undergoing an operation for your trigeminal neuralgia, you may find yourself in a scenario where nothing else has worked and surgery is your only remaining alternative.
Considering Trigeminal Neuralgia Surgery
When relief measures, including medication, have failed to control or relieve your pain, your practitioner may suggest trigeminal neuralgia surgery. Like any other type of surgery, treatment for trigeminal neuralgia must be weighed in terms of benefits and cautions. Different types of interventions may be suggested to address your trigeminal neuralgia, including:
- Microvascular decompression (MVD) surgery: This is often the first line of recommendation for many patients after medication has failed. Microvascular decompression relieves pressure on the trigeminal nerve by placing a teflon sponge between the trigeminal nerve and the offending blood vessel compressing against the root of the nerve.
- Gamma Knife Radiosurgery (GKRS): For patients who are not candidates for microvascular decompression or prefer a less-invasive approach, GKRS is another first-line treatment option. Gamma Knife Radiosurgery focuses multiple beams of radiation on target areas of the trigeminal nerve to eliminate pain signals without a hospital stay.
- Percutaneous rhizotomy: After microvascular decompression and Gamma Knife Radiosurgery have been considered or tried without success, percutaneous rhizotomy can be considered. Percutaneous rhizotomy uses a specialized needle, inserted through the mouth using X-ray guidance to intentionally damage a specific branch (or branches) of the trigeminal nerve, thus blocking abnormal pain signal transmission to the brain.
- Pain stimulator placement: After other treatment options have either been tried or discussed, placing a pain stimulator may bring about the relief other therapies failed to achieve. With this intervention, implanted stimulator electrodes (wires) are placed along specific regions of pain. These wires are connected to a pacing unit similar to a pacemaker for the heart. This technology “paces” the abnormal nerves into a more coordinated and synchronized pattern of firing that hopes to reduce otherwise untreatable pain symptoms.
Your neurosurgeon will work with you to determine which of these procedures might be of the most benefit to your particular case.
Questions to Ask Before Trigeminal Neuralgia Surgery
To best understand what to expect before, during and after your surgery, you should discuss the following questions with your provider:
- Which types of doctors and specialists will be on my neurosurgical team?
- How long will my trigeminal neuralgia surgery last and what is the expected time frame for a hospital stay if necessary?
- Will I need to undergo any physical or occupational therapy after surgery?
- How soon after the procedure is it realistic to expect positive changes in pain levels?
- How soon after treatment will I be able to reduce my current dose of pain medication?
- What type of follow-up will I need?
- What preparations do I need to make prior to my surgery?
- If I do not achieve optimal results through my surgery, what are my next steps?
Just Before Trigeminal Neuralgia Surgery
During the weeks and days leading up to your trigeminal neuralgia surgery, you’ll likely go for pre-surgical testing that often includes basic blood work, a chest X-ray and an EKG. Any time a patient has to undergo general anesthesia, a careful review of their general health and medical history is indicated to minimize the risk of potential adverse events. Most often, new brain imaging is not necessary as the imaging acquired during the decision-making process is all your surgical team should need to perform your procedure safely on the day of surgery.
The night before MVD surgery, you’ll be asked not to eat or drink anything after midnight to ensure the mixture of food and anesthesia will not sicken you during surgery. For Gamma Knife Radiosurgery, fasting is often not required. In all cases, you’ll be advised to have someone drive you to and from the hospital or surgical center.
Just After Trigeminal Neuralgia Surgery
If you undergo MVD surgery, once your surgery is finished, you will go to a recovery room where you’ll be monitored closely as the anesthesia wears off. If you elect to undergo Gamma Knife Radiosurgery, once the procedure is finished, your headframe will be removed and you will be observed for about one hour. Once you feel comfortable, you will discharged homw with instructions on the same day.
Pain after MVD surgery is normal. It’s possible that you may be able to see the distinction between your post-surgical pain and trigeminal neuralgia pain. Your doctor will want to ensure you can cope with post-surgical pain without the need for IV pain medicine before you are released from the hospital. Pin site discomfort and forehead swelling after GKRS is common and can last about 3-7 days. Although mild, patients often take tylenol for discomfort.
After recovering at home, your doctor will work with you to set a weaning schedule for pain medication needed after the surgery until it reaches a minimum or zero level after a certain time. If the surgery has successfully ablated your trigeminal neuralgia nerve pain, you may find yourself reduced to a level of needing no pain medicine in a matter of weeks.
Deciding to undergo surgery is always a serious consideration. Trigeminal neuralgia can have an absolutely debilitating influence on your life, which is why seeking surgical intervention may be your best option as you work past living in constant pain.
