Trigeminal Neuralgia

At Indiana University Health Neuroscience, our experts provide comprehensive evaluation and sophisticated treatment of trigeminal neuralgia. Trigeminal neuralgia is a chronic nerve disorder and one of the most painful conditions imaginable. The trigeminal nerve carries sensation from your face to your brain. If this nerve becomes compressed by an artery at the brainstem level, it can produce stabbing or electric, shock-like pain. Doctors do not know its exact cause, but trigeminal neuralgia is more likely to affect people who are older than 50 and those who have other health problems. It is more common in women than men, and is seen in up to 5 percent of patients with multiple sclerosis.

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1. Symptoms  
2. Diagnosis  
3. Treatment Options  
   

Symptoms

The key symptom of trigeminal neuralgia is sudden shooting or stabbing pain along one side of the face. People describe this pain as feeling like an electric shock or lightning bolt that can last up to several seconds. Certain everyday activities such as brushing your hair or teeth, putting on makeup, chewing food or simply touching your face can bring on painful episodes. Trigeminal neuralgia pain can come and go, and there may be long periods of remission with no pain. Remissions can last for years, months or weeks, but attacks usually become more frequent and intense over time. Eventually these attacks may occur daily.

Diagnosis

Our experienced doctors are experts at diagnosing trigeminal neuralgia. To confirm the condition, they rely on a physical exam and patient history that describes a characteristic pattern of severe, sudden facial pain. Doctors may also conduct MRI or CT studies.

Treatment Options

There are several ways to treat trigeminal neuralgia, ranging from medication to a variety of surgical options. IU Health Neuroscience offers the full range of the most innovative treatments and our highly skilled doctors determine the best course of therapy for each person.

Medication

Your doctor may prescribe anticonvulsant medications to treat trigeminal neuralgia. These medications lessen or block pain signals sent to the brain, and are the most common initial treatment. Over time, however, you may experience breakthrough pain. Additionally, higher doses can produce side effects that affect memory and balance, which can be a problem, especially for older people. If medication is not sufficient, you may need to explore surgical options.

Surgery

The goal of any surgery for trigeminal neuralgia is either to stop the blood vessel from compressing the trigeminal nerve or to damage the nerve to keep it from malfunctioning. The different surgeries performed at IU Health Neuroscience include:

Stereotactic Radiosurgery (Gamma Knife)

Stereotactic radiosurgery, or Gamma Knife surgery, is a non-invasive treatment that uses targeted radiation to cause mild damage to the trigeminal nerve, which reduces pain signals sent to the brain. Our radiation oncologists and neurosurgeons use 3D images of the brain to deliver very high doses of radiation directly to the area where the nerve is compressed. Because the treatment is so precise, there is little exposure to surrounding healthy tissue. According to recent studies, this method takes away pain in 80-85 percent of patients, with 20 percent reporting a decrease in facial sensation.

Gamma Knife surgery is the latest surgical treatment for trigeminal neuralgia. The procedure is painless, typically done without anesthesia, and has very few complications. However, it can take 4-6 weeks to be effective. It is especially appropriate for older people who have other health problems.

Microvascular Decompression (MVD)

Microvascular decompression (MVD) gets at the root cause of trigeminal neuralgia and is most likely to stop the pain with no nerve injury. During the operation, which requires general anesthesia, a very small opening is made in the skull just behind the ear. Indiana University Health neurosurgeons locate the nerve where it leaves the brainstem. If they find a blood vessel pressing on the trigeminal nerve, a soft piece of shredded Teflon is placed between the vessel and the nerve, lifting it away from the nerve and alleviating pain by eliminating compression. According to published reports, the surgery is 90 percent effective for the first two years, and 80 percent effective over 10 years. The same reports find that facial numbness occurs in about five percent of cases. MVD is often recommended for younger patients who have few health problems and can tolerate general anesthesia.

Percutaneous Needle Procedure 

In this method, a needle is inserted into the skin beside the mouth and moved towards the trigeminal nerve. Once the location is confirmed, the needle tip heats to a carefully controlled high temperature and damages the nerve. The procedure can be done in an outpatient setting, and 90 percent of people say they feel almost immediate relief according to recent studies. However, the same studies indicate that after two years, 40 percent of people report that the pain has returned. The percutaneous approach is best suited for older patients with medically unresponsive trigeminal neuralgia.

Balloon Compression

Balloon compression is performed while the person is under general anesthesia. This technique allows a neurosurgeon to insert a hollow needle through the face and into an opening in the base of the skull. A thin catheter with a balloon on the end is threaded through the needle. The balloon is then inflated with enough pressure to damage the nerve and block pain signals.

From diagnosis through treatment and recovery, IU Health Neuroscience provides the most experienced doctors and the most innovative treatment options for exceptional trigeminal neuralgia care. 

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