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Surgeries For Trigeminal Neuralgia

Trigeminal neuralgia is a condition that causes severe and sometimes long-lasting facial pain. Medication is the first line of treatment, followed by alcohol injections which can give temporary relief. The only permanent cure for the condition is surgery. There are several surgical options available to treat the condition and you and your doctor will want to discuss which surgical option may be right for you.

Permanent Pain Cessation

Microvascular decompression (MVD) is the surgical process by which blood vessels causing a compression of the trigeminal nerve are moved out of the pathway of the nerves, or removed altogether. The separation of the nerve root from the blood vessels should bring about a permanent cessation of the condition.

A small incision is made behind your ear on the side of your face where pain is experienced. A small hole is drilled into your skull, the brain is held out of the way of the nerve, and padding is placed between the nerve and the artery. If the doctor thinks the nerve is not compressed by an artery or vein, he may decide to sever the nerve.

Another treatment option is the glycerol injection, known as percutaneous glycerol rhizotomy (PGR). In this procedure, the doctor guides a needle through your face into an opening at the base of your skull and on into the trigeminal cistern, a sac of spinal fluid which contains the part of the trigeminal nerve that branches off into three parts, as well as a part of nerve root. With the help of imaging, the surgeon is able to position the needle in the exact location. Glycerol is injected into the sac, causing nerve damage within 3-4 hours. This serves to block trigeminal nerve pain signals. Some people report numbness of the face or tingling after the procedure.

Balloon Compression

Yet another surgical treatment involves balloon compression. Percutaneous balloon compression of the trigeminal nerve (PBCTN) involves the insertion of a hollow needle that is guided through your face and on into an opening at the base of the skull. A catheter with a balloon is threaded through the needle and then inflated, creating enough force to damage the nerve. Facial numbness is common with this procedure, and some may find it hard to chew.

Percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) involves electric currents applied to the nerve fibers, destroying them forever. The procedure is done under sedation, and as in the other procedures, a needle is guided through your face into the skull. An electrode is threaded through the needle and on into the nerve root. You will be brought out of sedation so you can tell the surgeon when you feel tingling as you are given some light electrical currents. Once the neurosurgeon knows which area of the nerve is responsible for your pain, you are put back under sedation, and the electrode is used to harm the nerve fibers so that a lesion is created. Facial numbness is par for the course with this procedure.

Cutting Or Rubbing

Severing the nerve, known as sensory rhizotomy (PSR) involves the actual cutting of the nerve. The unfortunate side effect of this procedure is permanent facial numbness. Sometimes the doctor will rub the nerve instead of cutting it, so as to cause trauma to the area.

Radiation or gamma-knife radiosurgery (GKR) is a high dose of radiation delivered to the root of the nerve. Relief from the pain is often a gradual process, and the procedure may need to be repeated. GKR is painless and performed without anesthesia.