Neuroscience Institute Swedish Cerebrovascular Center
In the video below, David Newell, M.D. talks about trigeminal neuralgia, who it affects, and how it’s treated.
View full text/transcript for this video
Trigeminal neuralgia is a condition characterized by episodes of intense facial pain that lasts from a few seconds to several minutes or hours. The pain occurs in areas of the face where the trigeminal nerve supplies normal sensation: cheek, jaw, teeth, gums and lips, and sometimes the eye or forehead. This condition causes sudden, sharp and very severe pain, usually only on one side of the face. The pain is described as feeling like stabbing electric shocks, burning, crushing, exploding or shooting pain.
Although tumors or blood vessels pressing on the nerve can cause trigeminal neuralgia, in some cases the cause is unknown. Patients describe areas on the face as being so sensitive that lightly touching the face or even air currents can trigger an episode of pain. However, in many patients, the pain is generated spontaneously without any apparent stimulation.
People with this condition may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. If left untreated, the condition tends to worsen over time. It affects women more often than men, and is more likely to occur in people over age 50.
Treatments for Trigeminal Neuralgia
Because of the variety of treatment options available, doctors usually can effectively manage trigeminal neuralgia with medications, injections or surgery. Treatment usually starts with medication. However, over time, some patients eventually stop responding to medications, or may experience unpleasant side effects. For those people, injections or surgery provide other treatment options. Other treatment options for trigeminal neuralgia include alcohol injection, glycerol injection, balloon compression of the trigeminal nerve, radiofrequency thermal rhizotomy, and surgical rhizotomy.
Medications are used to lessen or block the pain signals sent to your brain, and are the most common initial treatment for trigeminal neuralgia. Some medications include anticonvulsants or antispasmodic agents.
Microvascular Decompression Surgery
Microvascular decompression is a delicate procedure that is performed through a small opening behind the ear. The goal of this procedure is to prevent a blood vessel from compressing the trigeminal nerve. The surgery is performed under general anesthesia.
Through this small opening, the neurosurgeon uses a powerful microscope to view the trigeminal nerve. From here, the surgeon meticulously separates the nerve from the artery that is pressing against it. To relieve the pressure, the surgeon inserts a Teflon® pad between the artery and the nerve, keeping the artery from touching the trigeminal nerve.
Illustration: Compression of Trigeminal nerve
Illustration: Pressure on Trigeminal nerve relieved
To make sure that other nerves are not damaged by the surgery, the surgeon carefully monitors nerve function of the facial and acoustic (hearing) nerves. This is done by gently inserting tiny electrodes (metal wires that conduct mild electrical signals) into the muscles around the eye and mouth.
After the Procedure
Following the decompression procedure, the neurosurgeon closes the bony opening behind the ear, and you will be awakened and allowed to recover from anesthesia. Once this pressure has been relieved, patients often report immediate and complete relief from the pain. Most people stay in the hospital for observation overnight. Pain relief is usually immediate and medications are gradually discontinued over a two- week period following surgery.
Another treatment option for trigeminal neuralgia is radiosurgery. Gamma Knife radiosurgery involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. This treatment uses radiation to damage the trigeminal nerve and reduce or eliminate pain. Relief occurs gradually and can take several weeks to begin.
Read more about Gamma Knife for trigeminal neuralgia, performed at the Swedish Radiosurgery Center.
Full text/transcript for What Is Trigeminal Neuralgia? video
Trigeminal neuralgia is a painful condition in the side of the face where patients get extreme episodes of severe pain. It affects usually middle age and older adults. The trigeminal nerve, which controls the sensation in the face, is irritated for some reason and starts to discharge and the patient experiences severe pain.
The treatments that are available include medical treatments. There are various medications that are in the anticonvulsant family that can calm down the irritability and those are often very effective in reducing the severity or the frequency of the attacks.
Other treatments include what we term neuro-destructive procedures where the nerve is partially destroyed by either injection of a substance called glycerol or burned with a radiofrequency probe and there's another treatment called gammaknife treatment where focused radiation is actually delivered to the nerve to interrupt some of the fibers.
The other treatment is called microvascular decompression. Microvascular decompression is a procedure that usually addresses the cause of the trigeminal neuralgia, which is a vessel that is pulsating under the nerve. What's done is an incision is made behind the ear and then we go above the cerebellum in the brain and under a high powered microscope we find the vessel that's pressing on the nerve and then pad it away from the nerve with a small teflon pledget. This teflon pledget, that looks almost like teased up cotton, and it's place between the vessel and the nerve and prevents the vessel from pulsating into the nerve and causing the trigeminal neuralgia.
The procedure is an open surgery so there are small chances of complications like with any surgical procedure, including infection, fluid leak, and occasionally there are more sever complications like hearing loss or weakness of some of the nerves that go to the face, but the vast majority of the time patients do very well. It's usually about ninety percent effective in eliminating or significantly improving the symptoms in patients and that usually lasts over a long period of time, for example, typically ten to twenty years or longer.
Patients are extremely grateful after having had the procedure because the pain is one of the worst pains that you can have and it brings patients to their knees it's so bad and it's really disruptive to their lives. Many of the patients have reached very high doses of medication which interferes with their ability to think and function and so when the procedure works, which it does most of the time, patients are able to come off medications completely in most cases and have complete elimination of their pain.
At Swedish Neuroscience Institute we have a very high volume neurosurgical center and we have specialized staff including specialized anesthesiologists, operating room technicians, nurses, and specialized neurosurgeons who perform these procedures all the time.