Trigeminal neuralgia (TN) is a potentially serious neurological disorder involving one or more branches of the trigeminal nerve that serve the face. TN is most often caused by compression of the trigeminal nerve by an encroaching facial vein or artery, but sometimes the cause cannot be determined. Whatever the cause, TN is typically marked by the sudden onset of very severe and recurring stabbing pain in the face and/or jaw. Because of its location, TN is often misdiagnosed as a temporomandibular disorder (TMD, TMJ) or even as a psychosomatic disorder, but TN is very real and painful enough to be life-altering. TN often remits and recurs without warning, and left untreated, can shift from being intermittent to constant, and become so severe it causes permanent physical damage, so early diagnosis and appropriate intervention is important. “An accurate diagnosis is key in addressing TN,” says Ocala Neurosurgical Center’s Board Certified neurosurgeon Dr. Antonio DiSclafani. “Our team of neurosurgeons has extensive experience accurately evaluating, diagnosing and treating TN. We can differentiate it from TMD and other disorders causing facial pain.”
The first course of action is always specific prescription medications proven to address TN pain. However, the relief they provide may not last. “As many as 50+% of patients develop resistance to the drugs and the pain returns,” says Dr. DiSclafani. “Therefore, most TN patients who develop resistance to medication or are under age 60 when TN first strikes are candidates for effective neurosurgical treatment. Generally speaking, the sooner in the course of the disease we can intervene, the better the long-term outcome.”
Surgical treatments provided by ONC include:
Microvascular Decompression – MVD is the most common surgical approach to treating TN. Entering through a small surgical incision behind the ear, your surgeon will move the imposing artery or vein away from the trigeminal nerve, relieving pressure, and insert a small Teflon pad between the nerve and the compressing vessel. The pain relief provided by this procedure is highly effective and lasting for about 80% of patients, and delivers the best chance to reduce or eliminate medication. Because it is major surgery involving creating a small hole in the skull, patients typically remain in the ICU overnight and in the hospital for several days afterward. Patients are told to rest for four to six weeks following surgery.
Radiosurgery – Also known as Gamma Knife surgery, radiosurgery is the least invasive direct treatment option, and is performed as an outpatient procedure. Because it involves no cutting, it is not actual surgery, but rather the delivery of a targeted beam of radiation to the trigeminal nerve where it enters the brainstem. Radiosurgery doesn’t treat the cause of TN, but it can help to relieve its symptoms by damaging the trigeminal nerve and reducing its pain signals. More than 80% of patients find relief from Gamma Knife treatment, but it may take weeks or even months for significant relief to be achieved, so most patients will continue to remain on prescribed medication for at least three to six months afterward. Once full relief is reached, many patients are able to go off medication. Some patients find pain relief to be permanent, but for some pain may return as the nerve restores itself.
Radiofrequency Rhizotomy – Radiofrequency rhizotomy (also known as radiofrequency lesioning) is typically indicated for high-risk patients for whom open surgery is contraindicated, and for people suffering from multiples sclerosis, whose TN is often caused by MS instead of nerve compression. Radiofrequency rhizotomy is like radiosurgery in that it addresses pain by reducing the pain signals transmitted by the trigeminal nerve, but instead of using radiation, radiofrequency rhizotomy is performed by guiding an electrode through the cheek to the trigeminal nerve and numbing it with electric shocks. 9 out of 10 radiofrequency rhizotomy patients experience immediate pain relief, but facial numbness and a return of facial pain in the two to three years following the procedure may occur. Still, its safety compared open surgery make it a better option for high-risk patients who no longer respond to medication and whose TN is severe and/or constant.
If you suffer from facial pain, there is help. For more information about trigeminal neuralgia diagnosis and treatment options, please contact the helpful, knowledgeable staff at Ocala Neurosurgical Center.