Trigeminal neuralgia is a neuropathic disorder that affects one or both of the trigeminal nerve supplying the face.  It causes severe, sudden and brief stabbing episodes of facial pain. It can cause intense pain in the ear, eye, lips, nose, scalp, forehead, teeth or jaws. This disorder is generally known to develop after the age of 50 and females are most commonly affected by it.

The trigeminal nerve arises from one motor nucleus and three sensory nuclei that extend throughout the length of the brainstem. When the nerve is compressed by an artery or a vein, it causes symptoms such as extreme episodes of stabbing pain.

Diagnosis:

Although the diagnosis of trigeminal neuralgia is solely clinical, there are plenty of ways to evaluate and diagnose this condition. Typically, a patient describes his pain as ‘shock like’ or ‘bolt from the blue’ or ‘shooting’. The pain lasts for a few seconds and then subsides. This however occurs frequently – almost a hundred times in a day. Drinking, chewing, eating, washing face or even a breeze of air can trigger this pain. The individual suffering from trigeminal neuralgia then begins to avoid eating, shaving or talking to avoid this pain. It has been observed that the pain is generally confined to one or more divisions of the trigeminal nerve. It is also a known fact that the pain attacks become more frequent and the doses of medication need to be adjusted accordingly. If the pain is extremely severe, surgical intervention may be required.

After proper diagnosis, there are plenty of medical and surgical treatments available that can help reduce and relieve the severe pain caused by this disease.

Treatment

Medical therapy is considered as an initial option for the treatment before resorting to any kind of surgical treatment. Minimally invasive surgery is also risky at times and should be considered as the final resort.

• When surgical intervention is needed?

Up to 10% of TN patients may not respond to oral medication. If there is failure of at least 3 drug trials, or drugs are causing unacceptable side effects then surgical intervention is needed.

• What are the surgical options available?

Surgical interventions include microvascular decompression (MVD) or minimally invasive procedures including Gamma-Knife radiosurgery (GKS) or percutaneous treatments, such as balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation (RFTC).Among these MVD and RFTC are most effective modalities.

• What is MVD?

It involves open surgery and separation of the trigeminal nerve root entry zone from the offending vessel by virtue of Teflon sponge. It maintains the integrity of the trigeminal nerve following surgery. So the postoperative facial numbness and dysesthesia are rarely seen.

Disadvantages

• It has severe side effects like facial palsy, hearing loss, even death.

Radiofrequency thermo coagulation is a safe and proven means of treating trigeminal neuralgia. It uses radiofrequency to heat up a small part of the nerve tissue so that the pain signals are interrupted.

Under the guidance of X-Ray, the doctor guides a need to the target area and a microelectrode is inserted through the carefully guided needle and the stimulation process starts. This process helps the doctor determine the area of the nerve which requires being treated which provides maximum relief from pain. Radio frequency travels through the electrode and the surrounding tissue heats up to eliminate the pain pathways.

RFTC has a success rate of 80% – nearly100% for managing TN. Compared to other surgical  options RFTC can be performed in all the patients ranging from young to elderly, fit to poor surgical risk patients and can be repeated in the same patient. RFTC allows more selective destruction of trigeminal divisions, which is beneficial for patients with TN in single nerve distribution. Although RFTC may have significant benefits for some patients, the recurrence rate appears to be higher (15 – 20% in 12 months and 35 % in 5 years) which is lesser than other percutaneous procedures but higher than that of MVD (5-10% in 1 year and 18.3% in 5 years). But in this case the repeat RFTC is equally safer and effective.

When medical treatment fails to treat trigeminal neuralgia, neurosurgeons resort to RFTC to give patients maximum relief from the pain caused by this disorder. Depending on the age, the medical comorbidities and the risks, the doctor takes a call on which treatment is best suited for the patient.

There are plenty of options to consider for trigeminal neuralgia surgery. Talk to your doctor and understand which treatment will best suit your condition.