Trigeminal neuralgia

Overview

Trigeminal neuralgia is a chronic pain condition affecting the trigeminal nerve in the face. Patients with trigeminal neuralgia can experience excruciating pain from common activities like brushing their teeth or smiling.

Patients with this condition can experience intermittent pain that is initially mild but progresses to an aggressive pain that is unbearable. Trigeminal neuralgia is more common in women than men, and is more likely to occur in people aged 50 and older.  Patients with multiple sclerosis are also likely to develop trigeminal neuralgia.

Trigeminal neuralgia is typically caused when a blood vessel comes into contact with the trigeminal nerve at the base of the brain. This contact puts pressure on the nerve causing it to malfunction. It can also be caused by a tumor compressing the trigeminal nerve. Some people may experience trigeminal neuralgia due to a brain lesion or other abnormalities.

In treating trigeminal neuralgia, your care team may include the following specialty areas:

  • Dental medicine
  • Imaging
  • Neurology
  • Neurosurgery
  • Otolaryngology
  • Pain management
  • Radiation medicine

 

 

Symptoms

Symptoms for trigeminal neuralgia may include:

  • Sporadic stabs of pain
  • Pain attacks triggered by touching the face, chewing, speaking, brushing teeth, or even a cool breeze on the face
  • Episodes of severe, shooting pain that feel like an electric shock
  • Pain affecting one side of the face
  • Pain focused in one area of the face, and may be triggered by touching that area
  • Pain in the cheeks, gums, jaw, lips, teeth, and on occasion in the eye or forehead
  • Waxing and waning episodes of pain attacks
  • Pain attacks that become more frequent and intense over time

Tests and diagnosis

Trigeminal neuralgia is typically diagnosed based on the description of the pain. Your doctor will ask about:

  • The location of the pain – what part of the face is affected?
  • The type of pain – is the pain sudden, shocking and brief?
  • The pain triggers – was the pain caused by stimulation of the cheek?
     

During the course of your treatment, your doctor may perform several tests to confirm the diagnosis and determine the underlying causes of the condition. Your doctor may order an MRI scan of your head to determine if the condition is related to multiple sclerosis or a tumor or if a blood vessel is clearly in contact with the trigeminal nerve.

What sets us apart?

The facial pain specialists at Northwell have decades of experience diagnosing and treating conditions that affect the trigeminal nerve. Offering both surgical and non-surgical treatment techniques, we help reduce or eliminate the debilitating pain associated with this condition.

Each patient has an individualized care plan that is reviewed and updated by the team to ensure patients are receiving the best quality care. The best treatment option is determined based on the patient’s age, health status, and pain management abilities.

Treatment options

Percutaneous Procedures

Percutaneous rhizotomy is a minimally invasive procedure used to relieve the pain caused by trigeminal neuralgia by selectively damaging the part of the nerve causing the pain and suppressing the pain signal to the brain. The trigeminal nerve is accessed through a needle placed in the cheek and directed using fluoroscopic imaging into the exact portion of the trigeminal nerve which requires treatment. This procedure can be repeated if the pain recurs.

There are several types of percutaneous procedures:

  • Percutaneous glycerol rhizotomy: This procedure is performed under local anesthetics. A needle is inserted in the area beside the mouth up through an opening at the base of the skull. Dye is injected to ensure the needle is positioned properly in the Gasserion ganglion. Then the glycerol is injected, which numbs the nerve.
  • Percutaneous balloon compression rhizotomy: During this procedure a needle is inserted in the area beside the mouth up through an opening at the base of the skull. A catheter fitted with an inflatable balloon is pushed through the needle. The balloon is inflated to compress the nerve root.
  • Radiofrequency rhizotomy: During this procedure, patients are intravenously sedated while an electrode is placed into the gasserain ganglion. The patient is then woken and an electrical current is passed through the electrode. The patient is then asked if the sensation matches the location of his/her typical neuralgia. Once in the correct location, patients are sedated while a radiofrequency/thermal lesion is created.

Radiosurgery

Stereotactic radiosurgery is a form of radiation therapy that focuses high-power energy on a small area of the body. Though the word “surgery” is in the name, radiosurgery is a non-surgical procedure where no cuts are made on the body. Northwell offers patients several stereotactic radiosurgery options, including CyberKnife® and Gamma Knife®. These technologies target the nerve with very precisely directed high dose radiation, which also can interrupt signals traveling up the trigeminal nerve.

Microvascular decompression

Microvascular decompression is a procedure that moves blood vessels touching the trigeminal nerve out of the way. The surgery is performed through a small incision behind the ear of the side of the pain. A pad is placed between the nerve and the blood vessel to prevent future nerve contact.

Neuromodulation

Neuromodulation therapy stimulates selective portions of the nervous system. This procedure is often preferred because the nerve is being modified instead of damaged. There are several forms of neuromodulation, including:

  • Spinal cord stimulation: This procedure helps reduce the amount of pain signals that travel up the spine and stimulates nerves to release pain-relief chemicals. The stimulation device is implanted in two stages. A hollow needle is inserted into the epidural space. Through this passageway, thin wires are threaded up the spine. Patients spend a trial period with a pulse generator that supplies electrical currents to diminish pain signals sent to the brain. After the trial period that proved to positively affect the pain, a permanent device is implanted.
  • Occipital nerve stimulation: This procedure stimulates the occipital nerves (the nerves providing sensation to the back and top of the head). It is useful for many types of cranial pain syndromes.
  • Ganglion stimulation: The SPG-spenopalatine ganglion is a nerve center deep in the skull beneath the eye socket. Clinical trials are being conducted now at Lenox Hill testing a revolutionary implant, which has been shown in European studies to be highly effective in treating autonomic trigeminal cephalgia-cluster headache.

 

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