Treatment

Trigeminal Neuralgia can be a debilitating disease however if it is treated properly, some of the symptoms can be reduced and even cured. There are many different types of treatments for Trigeminal Neuralgia that are available; some are more effective than others. The common ways of reducing the symptoms of the condition is by surgery or medication.

Each of the treatments is more effective than others and they all have their advantages and disadvantages. The treatment that is used is often determined by how far advanced the disease is, as well as how they respond to one treatment versus another. Each one will be discussed in greater detail below.

Surgery

Surgery is one of the major treatments for sufferers of Trigeminal Neuralgia. The goal of doing this procedure is to correct the part of the trigeminal nerve that is responsible for the pain. The success of this procedure is dependent on damaging the nerve. As a result of this patients may experience some amounts of facial numbness.

Types of Surgery

Microvascular decompression (MVD) – Microvascular decompression (MVD) is a surgery where the part of the trigeminal nerve is damaged or destroyed. An incision is created behind one ear and then a small hole is made in your skull, where part of the brain is lifted to show the trigeminal root. The process is done by removing or relocating the blood vessels that are in direct contact with trigeminal root. If a vein is found resting on the trigeminal nerve it is removed. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery.

MVD is known to be very successful at reducing or stopping the pain people feel. However as noted with every other type of surgery that exists, then pain can reoccur.
MVD has a high success rate but there are also risks linked with it. There is a possibility that you could decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death.

Rhizotomy – Partial sensory rizotomy (PSR) involves the separation of the trigeminal nerve from the base of the brain. This is done by the doctor creating an incision behind your ear. From here they will be able to access nerve, where it is partially cut. The results of this treatment are very good; however people usually suffer from facial numbness. There is also the possibility that pain can recur. Generally if the doctor does not find an artery or vein in contact with the trigeminal nerve, he or she won’t be able to perform an MVD, and a PSR may be done instead.

Gamma-knife radiosurgery (GKR) – This method involves the use of a concentrated high dose of radiation targeted to the root of the trigeminal nerve. The radiation from the gamma knife surgery will damage the trigeminal never and this will result in the reduction of pain in the people who suffer from the condition. The results from this surgery will not be seen immediately. It takes between a couple of weeks to months before pain relief is felt. There is a 50% chance that the pain will be eliminated from doing this procedure, sometimes the pain may recur. Gamma Knife Surgery is overall painless and this is done without the patient needing anesthesia.

Alcohol injection – Alcohol injections are placed into the trigeminal nerve from branches of the nerve that leave the bones of your face. This treatment is known to leave people who suffer from the disease with temporary pain relief. This treatment is known to numb the areas for weeks and months. The downside to this is the fact that the relief is only temporary; as a result of this, multiple injections maybe needed.

Balloon compression – Balloon compression is often known as percutaneous balloon compression of the trigeminal nerve (PBCTN). In this treatment the physician will place a hollow needle through your face into and opening that is located at the bottom of your skull. Once this is done, then a very thin catheter that has a balloon on the end is run through the hollow needle. Once inside the balloon is inflated. The inflated balloon will have enough pressure where it is able to damage the nerve that is responsible for sending pain signals. This procedure is generally very effective at controlling the pain people feel. There are adverse side effects to having this type of surgery done. People often complain that they experience facial numbness and a high number have nerve damage.

Electric current – A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. How it works is the physician will thread a needle through your face and this will lead into an opening in your skull. Once this is in place, an electrode is threaded through the needle until it rests against the nerve root.

At this point an electric current will be passed through the tip of the electrode until reaches the proper temperature. This heated tip will begin to damage the nerve fibers and creates a lesion. Usually this will get rid of the pain, but if that does not occur, then the doctor may create additional lesions.

Facial numbness is a common side effect of this type of treatment. The pain may return after a few years.

Glycerol injection – The glycerol injection is a process where the doctor will insert a needle through your face and into the base of your skull. From here the needle is then guided to a small sac of spinal fluid that is contained in the trigeminal cistern. This fluid surrounds the trigeminal nerve ganglion. Once it is found by imaging, then the doctor will inject a small amount of sterile glycerol. Once this is done, then after a couple of hours, the glycerol damages the trigeminal nerve and blocks pain signals. It is effective in treating the condition in some people, but others the pain will return. The side effects are often facial tingling or numbness.

Medications

Despite surgery having better results, medication to treat trigeminal neuralgia is usually the first step in treating the condition. The medications that are used are usually effective in reducing and even stopping the pain signals that the brain receives. There are numerous drugs that are available and some are more effective than others. This is good for patients who stop responding to one medication or experience too many side effects. They can take another medication that could work better and have fewer side effects.

As stated above, there are many different medications that provide treatment for trigeminal neuralgia. Some of the more popular and effective ones are listed below.

Carbamazepine (Tegretol, Carbatrol) – Carbamazepine is known as an anticonvulsant drug. This is the most popular form of medication that is used for the treatment of trigeminal neuralgia. Carbamazepine is often used to treat the disease in its early stage. It is good at controlling the pain that many people suffer from. The downside to using this drug is the fact that it loses its effectiveness over time. General side effects are sleepiness, dizziness, nausea and confusion.

Baclofen – Baclofen is the second most popular drug that is used for the trigeminal neuralgia treatment. Baclofen is known muscle relaxant and its effectiveness seems to be increased when used with Carbamazepine or Phenytoin. The side effects associated with its use are similar to Carbamzepine and this would include confusion, nausea and drowsiness.

Phenytoin (Dilantin, Phenytek) – Phenytoin was the first medication that was used to try to control trigeminal neuralgia. It is an anticonvulsant medication. The side effects are usually drowsiness, dizziness and gum enlargement.

Oxcarbazepine (Trileptal) – Oxcarbazepine is similar to Carbamazepine and it is an anticonvulsant medication. The side effects associated with its use are usually dizziness and double vision.

Aside from these medications physicians usually might prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin).

For some people who take the medication; eventually they will stop responding to its treatment. That’s why it was stated that even though it is the first form of treatment, it is usually not the most effective. Some people might also experience horrible side effects and this could turn them off the medication. For people who fall into those categories, they will often opt for surgery or a combination of medication and surgery.

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