Is There a Surgery For Trigeminal Neuralgia?

Are you experiencing pain while putting makeup on your face or simply brushing your teeth? If the answer is yes, then you may be suffering from trigeminal neuralgia. It is a chronic condition with severe pain that impacts your trigeminal nerve. This nerve is responsible for transmitting pain signal from facial tissues to the brain. You will feel jolts of awful pain while doing normal daily activities involving your facial muscles and tissues.1

You could face mild and short pain symptoms in the beginning. But over time, the condition may advance and causing longer and more frequent episodes of stabbing or burning pain. The condition impacts females more frequently compared to men. Individuals over the age of 50 are more susceptible to trigeminal neuralgia.1,2

Is There a Surgery For Trigeminal Neuralgia?

Is There a Surgery For Trigeminal Neuralgia?

Having trigeminal neuralgia does not necessarily imply you will have to bear the pain for the rest of your life. Currently, there is no short of treatments and alternative therapies for trigeminal neuralgia. Your physician can suggest a surgical option, oral medication, or injectable drugs for the effective treatment depending on the severity of your condition.

Surgery is considered when patients stop responding to medications after a period of treatment. There are mainly two types of surgical process available for trigeminal neuralgia.2,3

Microvascular Decompression: This trigeminal neuralgia operation includes the relocation or removal of blood vessels touching or in contact with your trigeminal nerve to prevent malfunctioning of it. Usually, arteries and sometimes veins are also removed. A cushion is inserted between the blood vessels and the nerve. If the complication is more, parts of blood vessels or nerve endings are removed permanently. This surgery may eliminate or decrease your pain in the majority of the cases, but some individuals may experience recurrence of pain. The surgery has some complications and risk factors such as facial numbness, weakness of facial muscles, and reduced hearing ability, but they are rare.3

Gamma Knife (Stereotactic Radiosurgery Of The Brain): Here the surgeon delivers a targeted radiation dose to the base of the trigeminal nerve. Using radiation, this method destroys your trigeminal nerve to decrease or remove the pain completely. The relief happens gradually and usually takes more than a month. For most individuals, this procedure offers a successful elimination of facial pain. In some cases, facial numbness can be seen as side-effects.4

Other types of trigeminal neuralgia surgical procedures include rhizotomy, where the surgeon reduces pain by destroying the nerves. There are two types of rhizotomy:

Balloon Compression: Here your doctor reaches the trigeminal nerve by inserting a hollow needle through the skin of your face. A catheter with a balloon fitted at the end is inserted with the help of this needle. The balloon is inflated upon reaching the nerve fibers to destroy them. This blocks the possibility of pain signals reaching your brain. The process controls pain for most individuals for a substantial period.3

Glycerol Injection: A similar needle is inserted through the facial skin at the base of the trigeminal nerve. The only difference is that the nerve is destroyed by injecting sterile glycerol in small quantity. It reduces pain, but there is pain recurrence in some patients.5

Radiofrequency Thermal Lesioning: Another way to destroy trigeminal nerve is selectively damaging the nerves causing pain by a mild electric pulse. A similar needle is inserted through your facial skin and an electrode is passed through it. Your doctor will ask you to indicate where you feel more pain and try to selectively destroy those nerve fibers by heating the electrodes through the electric pulse.5

All these procedures can reduce the pain and provide relief, but have the side-effects of imparting some sort of facial numbness. There are also possibilities of pain recurrence in some individuals.

Conclusion

Trigeminal neuralgia may go away after some time, but it is unlikely. In most cases, medical intervention is needed and the early start of effective treatment procedure will help cure the disorder faster. Surgical treatment is a good option, particularly for patients who have stopped responding to medications. Recurrence of trigeminal neuralgia after surgery is possible and such patients should be re-operated using the different (interposing) technique.

References:  

  1. Love S, Coakham HB. Trigeminal neuralgia: pathology and pathogenesis. Brain. 2001;124(12):2347-2360.
  2. Burchiel KJ. Trigeminal neuralgia: new evidence for origins and surgical treatment. Neurosurgery. 2016;63(CN_suppl_1):52-55.
  3. Zeme SM. The Surgical Treatment of Trigeminal Neuralgia. 2016.
  4. Wolf A, Kondziolka D. Gamma knife surgery in trigeminal neuralgia. Neurosurgery Clinics. 2016;27(3):297-304.
  5. Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G. Trigeminal neuralgia–diagnosis and treatment. Cephalalgia. 2017;37(7):648-657.

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