Trigeminal neuralgia is a type of severe facial pain whereby sudden, electrical or stabbing pain that is felt on one side of the face. There is often a trigger, such as eating, brushing teeth, or even talking.
The pain comes from the trigeminal nerve usually because it is compressed by a blood vessel, although other causes such as tumours or multiple sclerosis must be excluded. The first-line treatment of trigeminal neuralgia is with medications.
Surgery becomes necessary when one of these occur:
- Pain that is not well controlled despite the best use of medications
- Intolerable side-effects from these medications (commonly sleepiness, dizziness, forgetfulness)
- Patients who do not wish to be on lifelong medications
There are 3 main surgical options for trigeminal neuralgia
There are three main surgical options, each with their own advantages and risks:
- Microvascular decompression
- Radiosurgery
- Percutaneous lesioning
Each of these surgical treatment has their roles.
Microvascular decompression
The most commonly performed surgical procedure is microvascular decompression as it is potentially curative (>90% initial rate of pain control, 80% long-term). It is also considered the most invasive as it aims to fix the underlying problem, namely the compression of the nerve by a blood vessel.
A small opening is made in the skull behind the ear, and a permanent padding is then inserted between the nerve and the vessel. This serves to separate the nerve from the vessel and hence decompress the nerve.
Radiosurgery
Radiosurgery is the least invasive treatment and uses controlled beams of radiation to target the nerve. The aim is to stop the transmission of pain signals but does not deal with the underlying cause. Therefore, the pain control is often not as effective as microvascular decompression.
Percutaneous lesioning
Percutaneous lesioning uses a fine needle to heat the nerve. Similar to radiosurgery, it aims to stop the transmission of pain signals but is again less effective.
An important thing to keep in mind is that the severe disabling pain of trigeminal neuralgia is treatable. With an individualised treatment plan developed after detailed assessment and discussion, effective treatment of trigeminal neuralgia is possible.
