When you are suffering from trigeminal neuralgia, surgery may become the recommended treatment for a number of reasons, including how you’ve responded to other treatments, the nature, course and severity of your disease, results of imaging studies, and your overall health.
As you prepare to work with your neurosurgeon in deciding whether to undergo trigeminal neuralgia surgery, use this guide to inform your discussion.
Trigeminal Neuralgia Treatment Failure
For most patients, the first line of treatment for trigeminal neuralgia (TN) is medication with “membrane stabilizers” including tegretol and trileptal. While medication can be effective for many TN patients, these medications may be poorly tolerated at times and cause unwanted side effects such as drowsiness, fatigue, feeling drunk or disorientation.
Nature, Course and Severity of Trigeminal Neuralgia
For some trigeminal neuralgia patients, pain occurs only intermittently and can be controlled with medication. If you are at the point of considering trigeminal neuralgia surgery, however, that likely does not correspond to the nature, course and severity of your disease.
If a specific cause is found for your pain, however, it often can be directly addressed surgically. For example, in certain cases, trigeminal neuralgia may be treated with the placement of a surgical sponge through microvascular decompression if the nerve is impacted by a blood vessel.
If your pain is poorly controlled by medicine, has lasted for a long time or has greatly worsened over time, it may be time to determine the best possible surgical intervention.
Imaging Tests and Trigeminal Neuralgia
Neurosurgeons use a variety of imaging tests to look for potential reasons or causes of your trigeminal neuralgia. These imaging tests include CT scans, MRIs and MRAs, all of which can be performed with or without the injection of contrasting dye. These test results will then become your surgeon’s best guide to determine whether surgical intervention is the appropriate response to your case of trigeminal neuralgia. Just as findings of nerve impingement might suggest microvascular decompression as a potential treatment option, imaging can also reveal other types of issues related to your trigeminal nerve.
Imaging can also help in the use of Gamma Knife Radiosurgery, typically the second type of “surgery” considered if microvascular decompression is not the best treatment option.
Exploring All Options
As you work with your neurosurgeon to determine your best course of treatment, open communication will guide good decisions. You’ve likely consult with several other doctors with different medical training before choosing a neurosurgeon, and sharing these previous medical records – including imaging findings, blood test results and previous therapies tried – is imperative.
While the decision to have surgery is never made lightly, it should never be a decision fraught with fear and anxiety. Our neurosurgeons will consider your entire case history and work with you to determine whether trigeminal neuralgia surgery is a good option. Once you’ve made your decision, your neurosurgeon will also work with you to ensure that you understand the procedure selected and to set realistic expectations.
