When you’re a trigeminal neuralgia patient whose symptoms aren’t effectively managed by medication alone – because of significant side effects or lack of pain relief – surgical techniques may become your only viable option for ending the hold that your trigeminal neuralgia pain has on your body. Several different surgical techniques are used in the treatment of trigeminal neuralgia. Take a look at each procedure and the potential risk each might pose. Work closely with your doctor to weigh those risks against the benefit you may gain so you can make the best possible treatment decision.
Microvascular Decompression Technique and Risks
Microvascular decompression (MVD) is typically the first surgical option considered when a nerve impingement is identified and you are in relatively good health. Because of the procedure’s complexity, however, MVD may pose the most trigeminal neuralgia surgery risks. The technique is performed by creating a small opening in your skull behind the ear on the side you are experiencing your trigeminal neuralgia pain. Once inside, an operative microscope is used to find the impingement and then a teflon sponge is placed between the impinging vessel and the nerve to end the transmission of pain.
Although quite rare, some of the risks of microvascular decompression surgery include numb spots on your face, weakness in your facial muscles, surgical site infection and impaired speech. Many of those side effects are temporary, however.
Gamma Knife Radiosurgery Technique and Risks
Sometimes, patients simply aren’t a good candidate for MVD, often because health issues preclude undergoing open surgery. The next best treatment choice is often Gamma Knife Radiosurgery. In actuality, this isn’t surgery at all – it’s a non-invasive procedure where multiple beams of radiation are used to disrupt the pain cycle caused by trigeminal neuralgia.
Your doctor will partner with a team of radiation specialists to identify via imaging where those beams will be directed and at what dosage. You’ll be placed in a headframe to prevent unintentional movements and the overall procedure is conducted fairly swiftly. You’ll likely return home the same day.
One of the most common risks associated with Gamma Knife Radiosurgery is fatigue after the procedure. This may last a few days and will abate on its own. Due to headframe placement, you may experience scalp and eye swelling, but this will also resolve in a matter of days.
Percutaneous Rhizotomy Techniques and Risks
Percutaneous rhizotomy, typically performed as an outpatient procedure, is a minimally invasive technique with low trigeminal neuralgia surgery risks. If you and your doctor have elected to undergo this procedure, you’ll first be sedated and a very thin electrode will be placed through your cheek and threaded back to the bottom of your skull, where the trigeminal nerve branches into its major divisions. Then, you’ll be woken to determine which area of the trigeminal nerve is causing your pain. While awake, the surgeon will use heat, pressure, or chemicals to intentionally injure the branch(es) of the trigeminal nerve causing your neuralgia.
Percutaneous rhizotomy carries similar risks to microvascular decompression. Among primary concerns are portions of your face which may be numb to touch, either just temporarily or sometimes permanently. You and your doctor may need to weigh the probability of experiencing relief from terrible pain with the potential of numb spots to determine if this procedure is the right approach to your case.
Another potentially permanent side effect of this procedure is called anesthesia dolorosa. Although uncommon, this potential side effect must be discussed with your surgical team prior to the procedure. After surgery, it’s likely that you’ll experience some swelling, bruising and pain around the area where the electrode entered your cheek. Very rarely, you may experience issues with your vision or jaw. Those risks only occur in a very small number of patients and mostly clear up within six months.
Pain Stimulator Placement Technique and Risks
The last line of treatment for trigeminal neuralgia is the implantation of a pain stimulator beneath your skin on the back of your head. These stimulators send electrical impulses along the nerve channel, effectively confusing it from being able to carry pain. Like a pacemaker, pain stimulators run on lithium batteries that must be changed over time.
The placement of a pain stimulator is done in two parts – first, a temporary placement of the electrode to determine effectiveness, and then a permanent placement specifically tuned to your needs. Because this pain stimulator must be implanted, this is considered moderately invasive surgery and will likely require at least one night spent in the hospital under observation.
Trigeminal neuralgia surgery risks associated with the placement of a pain stimulator are typically minimal. Some patients may experience pain and swelling around the implant. A small number of cases may lead to infection at the implantation site. And like any device, a pain stimulator can fail over time and may need to be removed and replaced occasionally.
Making the Best Choice
No two cases of trigeminal neuralgia are perfectly identical. Speak frankly with your neurosurgeon about your surgical and medical history as well as the course of your battle with trigeminal neuralgia. After considering the full picture of your health and needs, you and your doctor can proceed with the best surgical option so you can get back to leading a pain-free life.
