When Do You Need Surgery for Trigeminal Neuralgia Pain?
Trigeminal neuralgia may progress and transform from typical trigeminal neuralgia into atypical TN2 wherein the pain becomes more prominent, constant with the risk of developing sensory impairment. Therefore, early surgical intervention can help relieve pain without causing any sensory defects.
With every passing day the pain associated with trigeminal neuralgia increases and becomes extremely unbearable. In such cases, medication may not work efficiently. The best trigeminal neuralgia treatment option that your neurosurgeon suggest for you is surgery.
The following surgical procedures are available for trigeminal neuralgia pain:
- Stereotactic radiosurgery
- Gamma knife radiosurgery (selectively targets affected trigeminal nerves with focussed radiation)
- Microvascular decompression (Affected blood vessels are treated)
- Percutaneous balloon compression
- Percutaneous radiofrequency rhizotomy (Selectively targets affected trigeminal nerves branches)
In this type of treatment, neither incisions are made nor general anaesthetic is used, but a local anaesthetic is used. A metallic frame is fixed to the head with four pins. The areas where the pins are inserted is numbed with a local anaesthetic.
The procedure may go on for one to two hours (stereotactic radiation therapy continues during this time). After completion of the treatment, the patient is allowed to rest for a short time – and can go home afterwards. The changes can be noticed after a few weeks or months after stereotactic radiosurgery.
Gamma knife radiosurgery (selectively targets affected trigeminal nerves with focussed radiation). The trigeminal neuralgia treatment is a type of stereotactic radiosurgery treatment – which is non-invasive, painless and effective. The treatment can be done on an outpatient basis.
Microvascular decompression (MVD) is a surgical procedure to treat trigeminal neuralgia pain without intentionally damaging the trigeminal nerve. The objective of this surgical procedure is to release the pressure developed by the compression of the trigeminal nerve by the blood vessels that are compressing the nerve or wrapped around the nerve.
A skilled, trained, an experienced and qualified neurosurgeon can diligently and dextrously perform this procedure efficiently. It is a major surgical procedure which is performed under general anaesthesia.
Once the blood vessels are separated from the nerve, a non-absorbable material like TEFLON or DACRON is shaped like a cushion and interposed between the blood vessels and trigeminal nerve at its origin from the brain-stem – which is the point of great importance.
This area, which is known as “TRIGEMINAL ROOT ENTRY ZONE (TREZ) is the place where the nerve root is not covered with a protective sheath known as MYELIN. The pain stops or eases completely– giving a sigh of relief to the patient.
When you compare this procedure to any other treatment, it provides the closest possible cure for trigeminal neuralgia as microvascular decompression provides long-lasting pain relief. It is, in fact, the gold standard treatment for trigeminal neuralgia.
Percutaneous Balloon Compression
This type of procedure is performed to sever the pain-causing trigeminal nerve. It is a deliberately done procedure to damage the trigeminal nerve that is causing pain. In this procedure, a tiny tube is inserted through the cheek and a balloon is threated along with it until the balloon reaches Gasserian Ganglion – where the balloon is inflated and squeezed around the ganglion.
The balloon is removed after the procedure. The aim of the procedure is to disrupt the pain signals passing through the nerve. The procedure is a daycare as the patient can go home the same day after taking rest for some time.
Percutaneous radiofrequency rhizotomy (Selectively targets affected trigeminal nerves branches)
Percutaneous stereotactic rhizotomy (PSR) is a procedure that involves selective suppression of the pain signals passing to the brain by damaging the part of the nerve that is causing pain.
Your neurosurgeon introduces a hollow needle through your cheek and directs it to the selected nerve. Current is then passed through the electrode to heat and destroy some of the nerve fibres responsible for pain. Though the entire nerve is not destroyed, the affected facial area may develop mild to major numbness.
Thus, long-term pain relief can be accomplished with some degree of facial numbness – which is the expected outcome of the procedure. The procedure is suitable for those patients who are unfit or unwilling for surgery and are suffering from recurrent severe and debilitating pain.
In terms of lasting pain relief, this procedure being less invasive scores high and thus it is one of the most effective procedures, but it comes with a few risks and other serious side effects including facial numbness (teeth, gums, cheek and tongue) and loss of corneal reflex, double vision and weakness in the jaw.
To summarise, the patient and the family have to decide THE BEST procedure for pain relief taking into consideration the above-mentioned facts and details.
MBBS, M Ch (Neurosurgery – AIIMS)
Senior Consultant Neurosurgeon