Bilateral trigeminal neuralgia can be a daunting and frightening condition. You may be wondering if there’s any way to find reliable relief from the overwhelming pain and sensations that you’re experiencing. Although bilateral trigeminal neuralgia is a more rare occurrence, you can still find relief from the same methods used for unilateral trigeminal neuralgia.
Understanding Bilateral Trigeminal Neuralgia
Trigeminal neuralgia is essentially the misfiring of the trigeminal nerve due to damage or trauma to the nerve. It can also be the result of compression from an adjacent blood vessel. The resulting symptoms manifest as shock-like spurts of pain that can be fleeting or last up to a few minutes. In the common form of trigeminal neuralgia, only one side of the face is affected, and it is always the same side. When considering bilateral trigeminal neuralgia, these flashes of pain can occur simultaneously on both sides of the face, or at different times on one side or the other. Bilateral TGN only makes up about 3 percent of the total number of cases of this condition.
Treating Bilateral Trigeminal Neuralgia
The treatment methods for bilateral trigeminal neuralgia are the same as those used for the unilateral cases. There are a number of options available to help relieve the pain and discomfort associated with these disorders.
Medication Options
Your doctor will initially recommend a conservative approach to treating your bilateral TGN. This first step involves prescribing medications that will work directly on the nerves. There are two medications that have proven to be effective — Tegretol and Trileptal. These anticonvulsants help prevent the abnormal impulses that cause the shock-like pain sensations you’ve been experiencing.
In some instances, medication may not be effective for you. There are two reasons this can happen. The first is that the medication doesn’t address the symptoms adequately, and you’re prescribed increasingly higher doses. You still continue to experience “breakthrough” pain after you’ve reached the maximum allowable dosage. The other is that you might have side effects including nausea, lethargy or dissociation.
Are you out of options to eliminate your pain?
Microvascular Decompression Surgery
Microvascular decompression (MVD) surgery is considered the gold standard of surgical interventions for bilateral trigeminal neuralgia when medication has proven to be ineffective. It is best suited if you are young and in good health. If you think you’d like to explore having MVD surgery, you will need to have a special imaging study known as a FIESTA MRI. This will allow your doctors to determine if your bilateral TGN is being caused by a blood vessel compression. If it’s found that it is, you are likely a great candidate for this surgery.
Microvascular decompression surgery for trigeminal neuralgia entails your surgeon creating a small opening in the bone tissue at the base of your skull, right behind and below your ear. This opening is about the size of a quarter. This will allow access to the nerve and blood vessel. Using microsurgery instruments, including a surgical microscope and specialized instruments, your surgeon will locate your trigeminal nerve and the artery or vein causing the compression. The vessel will carefully be lifted, and a tiny Teflon cushion will be placed between it and your trigeminal nerve. This will effectively create a buffer that will prevent irritation of the trigeminal nerve.
The procedure itself takes about two hours, and recovery is typically a few weeks. You will probably notice some immediate relief from your symptoms, and it will continue to improve as you heal.
Gamma Knife Radiosurgery
If it’s revealed you’re not a good candidate for MVD surgery, your surgeon may recommend Gamma Knife Radiosurgery (GKRS). This is an excellent option if you cannot undergo anesthesia or your bilateral trigeminal neuralgia is caused by something other than compression. Despite the name, GKRS is a completely non-invasive procedure that uses radiation to damage the affected area(s) of your trigeminal nerve, blocking the impulses that are causing your trigeminal neuralgia pain symptoms.
GKRS involves the targeting of around 200 tiny beams of radiation on the area of the nerve to be treated. The majority of people who have GKRS only require one treatment. You will be able to return home the same day as your procedure but will be encouraged to rest for a day or two. The results of GKRS are gradual — you will usually see full results within a few months.
Percutaneous Rhizotomy
If you aren’t finding relief from medication and aren’t determined to be a good candidate for MVD or Gamma Knife Radiosurgery, you may be referred for percutaneous rhizotomy. This procedure involves you being fully sedated (but not anesthetized). Your surgeon will then use a special needle that is guided to one or more branches of your trigeminal nerve. Heat, balloon compression or glycerol is then administered to cause damage that will prevent the nerve from relaying the painful impulses. Once you’ve recovered from sedation, you will be instructed to apply ice to the injection site and rest. You may experience some immediate relief but can expect full results to occur within a few weeks to months.
Stimulator Placement
The final option for your bilateral trigeminal neuralgia is stimulator placement. Tiny electrodes are threaded under your skin and to the offending area(s) of your nerve. They are then connected to a stimulator that delivers mild electrical pulses that disrupt the nerve impulses. After an initial trial, a permanent stimulator will be placed under your skin and attached to the electrode. It is an excellent option if you don’t want to undergo surgery.
Options for relief from your bilateral trigeminal neuralgia are greater than ever. Working closely with your doctor, you can be on your way to living your life pain- and symptom-free.
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