Surgery

Out of the many different treatments for Trigeminal Neuralgia, surgery is one of the most common methods to reduce the pain that is often associated with the condition.

Surgery is often recommended to relieve the pain associated with Trigeminal Neuralgia. The surgery will often try to relieve the pressure that is placed on the nerve. It is also done to try and selectively damage the nerve as a way to disrupt the pain signals, so that they won’t reach to the brain. It has been reported that there has been a 90 percent success rate in doing the different surgical procedures.

Most surgical procedures for trigeminal neuralgia aim to interrupt or block the electrical activity of the nerve and hence stop the pain. There are several different effective surgical procedures, but all of them carry some risk of failure or complication. It is still not clear whether those patients having surgery earlier rather than later in the course of the disease do better long term. Some neurosurgeons suggest that the changes which occur to the nerve due to long term compression may be harder to reverse if they have been present for longer.

Surgical treatments that are available include:

Peripheral surgery

Peripheral surgery is often done in a very close proximity to where the trigger area is located. The procedure may either be alcohol block, laser, neurectomy or cryotherapy. This procedure is often done once the patient is put under local anesthetic. Once the surgery is finished, the patient may require the use of stitches inside the mouth. This type of treatment will only give short term pain relief and at times can only last around 10 months. There are very few complications associated with this procedure and patients only need to take regular medication. Peripheral surgery to treat trigeminal neuralgia is not used very often to treat the condition as newer and better resulting procedures are available.

Minor surgery

Minor surgery is a non invasive surgery as no cutting into the patient would be done. In this procdedure an instrument is passed just inside the skull under Xray control to enter the Gasserian ganglion. This minor surgery is often performed once the patient is under a short anesthetic. It is quick and the patient can be released the next day to go home.

Major Surgery

Major surgery is another way to treat Trigeminal Neuralgia. This is done when surgery is done at the back of the skull right behind the ear. The area of pressure that is responsible for the pain is often highlighted with the use of a MRI or MRTA. This type of surgery is also done under full anesthetic.

Microvascular decompression – this procedure is the only one where the main purpose is not to destroy the nerve. The overall aim is to try and lift and move the blood vessel that is pressing on the nerve inside the brain. For people who choose to have this type of surgery, they will usually have a small scar as a result of this surgery. This type of surgery is the best for Trigeminal Neuralgia as patients have been known to get up to 8 years relief from pain. The success rate is around 50% of the patients. The chance of death from the surgery is very low, around 0.5%. Side effects can occur, as with any surgery. The main side effects that may be encountered are deafness, numbness and stroke. Neurosurgeons that specialize in this specific type of procedure can reduce the complications that can occur.

Rhizotomy – if no compression is found at surgery then the surgeon may opt to partially cut the nerve. This can offer some amount of relief, however it results in patients losing sensation in one side of the face and the other complications are as above.

Radiosurgery, Gamma knife surgery

Gamma Knife Surgery has been around for awhile to treat people who suffer from Trigeminal Neuralgia. This type of surgery is non-invasive and they often target the damaged regions with high doses of gamma rays. Once high quality images are gained from using the MRI and special equipment, a strong beam of radiation is directed at the nerve in the brain. This procedure is non surgical but it is often placed in the category of day case surgery. Pain associated with the disease is not relieve immediately and it may be three months before complete pain relief is obtained. For the best results this type of pain relief will probably take years.

Other Types of Treatment

Radiofrequency thermocoagulation – passing a current through the nerve which generates heat.

Glycerol injection – bathing the nerve in a toxic substance which over a few days destroys the nerves transmitting pain.

Balloon micro compression – the nerve is compressed by a small balloon which is blown up for a few seconds

These other methods of treatment offer some amount of relief for people who are suffering from Trigeminal Neuralgia. They have side effects associated with their use and the majority results in some amount of numbness. The most severe side effect that can occur is anaesthesia dolorosa. Some patients may experience numbness and it can affect the eye. If this occurs, then special protective glasses have to be worn to protect the eye from getting scratched. For patients who opt to get the glycerol injection, there is the least amount of numbness using this method. Usually paint relief will last around 3-4 years. Each one of these procedures can be repeated.

Which Surgical Treatment is Best for You?

If you are thinking of getting surgery for your Trigeminal Neuralgia then you will discuss the various aspects such as risks and benefits with your neurosurgeon, pain specialist or neurologist. They will be able to tell you the best options and how it can also affect you negatively. The choice for surgery however is a decision that the patient needs to do on their own and also weigh the options.

What Are the Possible Complications of Trigeminal Neuralgia Surgery?

As with any surgery, there is some type of risk that is usually associated with it. These will vary depending on the type of surgery that you do. The one thing with surgery is the possibility to make things worse. For Trigeminal Neuralgia this is a high possibility and could make more occurrences of the pain or even make it worse. The types of complications are listed below.

cranial haemorrhage leading to a stroke;

eye infections due to loss of sensation;

hearing loss on one side;

difficulty with eating;

surgical-wound infection;

generalised infection;

loss of sensation or alteration in sensation on one side of the face;

continuous pain in an area that is numb, (“anaesthesia dolorosa”).