When is surgery necessary for trigeminal neuralgia?

Doctor's Answers 1

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:

  1. Pain that is not well controlled despite the best use of medications
  2. Intolerable side-effects from these medications (commonly sleepiness, dizziness, forgetfulness)
  3. 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:

  1. Microvascular decompression
  2. Radiosurgery
  3. 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.

Similar Questions

What is Trigeminal Neuralgia?

Trigeminal Neuralgia is not a common disorder, but is also not as uncommon as you think. Trigeminal Neuralgia is a type of facial pain that affects half the face and has a very characteristic feature, like sharp and shooting pain. We’re not really sure what the incidence is in Singapore. There is no exact data, but around 0. 03% of the population has it. So, maybe several thousand patients have it per year.

Photo of Dr Nicolas Kon

Answered By

Dr Nicolas Kon

Neurosurgeon

Who is at risk for Trigeminal Neuralgia?

If you look at what percentage of the population is bound to have Trigeminal Neuralgia, it estimates up to 0. 3% of the population. How many new patients have it per year? Maybe less than 0. 03% of people will have this per year. If you translate this to the population of Singapore, we are looking at about 800 patients with facial pain per year. We have no real statistics collected in Singapore for this disease. In terms of pre-deposition, it tends to affect people in their 50s and tends to affect females more than men.

Photo of Dr Nicolas Kon

Answered By

Dr Nicolas Kon

Neurosurgeon

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