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Trigeminal neuralgia

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Surgical procedures

The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of the pain. Because the success of these procedures depends on damaging the nerve, one side effect is facial numbness of varying degrees. These procedures involve:

  • Alcohol injection. Alcohol injections under the skin of your face at the areas of pain may offer temporary pain relief by numbing the areas for days or months. Because the pain relief isn't permanent, you may need repeated injections.

  • Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR), Percutaneous means through the skin. Your doctor inserts a needle into the trigeminal cistern (a small sac of spinal fluid that contains the trigeminal nerve ganglion and part of its root). Images are made to confirm that the needle is in the proper location. Once the location is confirmed, your doctor injects a small amount of sterile glycerol. After 3 or 4 hours, the glycerol damages the trigeminal nerve and blocks pain signals.

  • Initially, PGR relieves pain in most people. However, many people have a recurrence of pain, and many experience mild facial numbness or tingling.

  • Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in your skull. Then a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals.

  • PBCTN successfully controls pain in most people. Only a small number of people experience a recurrence of pain. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage, resulting in a temporary weakness in the muscles used to chew.

  • Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root.

  • The electrode is positioned so that you experience numbness or pain. An electric current is passed through the tip of the electrode until it is heated to the desired temperature for about 70 seconds. This damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions.

  • PSR successfully controls pain in most people. A common side effect of this type of treatment is mild to severe facial numbness.

  • Radiation. Gamma knife radiosurgery (GKR) involves delivering single high doses of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and eliminates the pain. GKR is successful in eliminating pain more than half of the time. The procedure is painless and typically is done without anesthesia. Because it's relatively new, the long-term risks of this type of radiation are not yet known.

  • Severing the nerve. Your doctor may work through a small incision to cut the branch of the trigeminal nerve that's causing the pain as that nerve branch leaves your skull and before it reaches your facial area.

Microvascular decompression (MVD)

A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that have contact with the trigeminal root and separating the root and vessels with a small pad.

During MVD, your doctor makes a small incision behind one ear. Then, through a quarter-sized hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove an artery that is found to be compressing the trigeminal nerve.

MVD can successfully eliminate or reduce pain almost all of the time, but as with every other surgical procedure for trigeminal neuralgia, pain can recur in some people.

While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision and even a stroke or death.


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