What is Trigeminal Neuralgia?
Trigeminal neuralgia is also known as painful face syndrome. They are sudden, stabbing or electric shock-like attacks that extend to the eyes, teeth or jaw on one side of the face. The pain usually comes in the form of short-term attacks, but sometimes it can last for hours without interruption. There may be some factors that trigger pain and vary from person to person. As an example of these;
- Wind
- Cold weather
- Chewing bite
- Brushing teeth
- Touching the face
- Talk
In 95% of people, pain is felt in one half of the face and does not pass to the other side. The cause of this disease is often the pressure of a vessel in the brain on the fifth cranial nerve, called the trigeminal nerve.
Diagnosis
The diagnosis of the disease is made by considering the patient’s complaints and examination findings. Brain MRI can reveal the presence of a vessel, tumor or similar condition that presses on the fifth nerve.
Treatment
After the diagnosis of trigeminal neuralgia, the patient should first avoid if there is a known triggering factor such as wind or cold that triggers the pain. The first step of treatment is drug therapy. Some drugs that are normally used in epilepsy or nerve damage are also beneficial in trigeminal neuralgia. If drug treatment fails, other methods of treatment are applied. Today, the most proven treatment method is microvascular decompression surgery.
Percutaneous Interventions
These interventions are usually performed while the patient is awake. Accompanied by special imaging methods, the process of blunting the sensory fibers is performed by reaching the place where the nerve exits the skull or another targeted part of the nerve with a needle, by giving various chemicals to this part of the nerve, by creating pressure with a balloon or by giving high heat called radiofrequency thermo-ablation. Although these methods provide temporary benefits, their results are usually not as good as microvascular decompression surgery in the long term. In addition, permanent numbness may develop on the face side of the face where there is pain after wig methods.
Surgical Methods
Microvascular Decompression: The most frequently applied open surgical method and the one with the most proven effectiveness and reliability is the “microvascular decompression” surgery. In this surgery, the root of the painful nerve is reached through a small incision behind the ear, and the vessels that put pressure on the nerve in this area are separated and the nerve is relieved. To prevent the same situation from recurring, a long-term effect is achieved by placing a Teflon-like polytetrafluoroethylene (PTFE) pad between the nerve and the vessel. The success rate of the surgery has reached up to 95% today. The effect is usually seen immediately and the patient’s pain is gone before he is discharged. There are chances of infection, cerebrospinal fluid leakage and not benefiting from the surgery, which can be seen in every surgery, although they are low. Death is very rare. This procedure can be done with the help of an endoscope and microscope. In this way, the transaction can be successfully completed by entering an opening approximately the size of a 1 TL coin. In addition, a method called neuromonitoring during surgery prevents any damage to the nerves and brainstem.
Stereotactic Radiosurgery: Another method that can be used in the treatment of trigeminal neuralgia is stereotactic radiosurgery. It is generally preferred in patients who are not suitable for microvascular decompression surgery or who have not benefited from various treatments before. A device called a stereotactic frame is placed on the patient’s head with the help of special screws by anesthetizing it with local anesthesia, then the necessary calculations are made and it is taken to the radiosurgery device. The treatment is terminated after approximately 30-45 minutes of radiation application without feeling any pain. The goal of this treatment is to destroy the root of the nerve that causes pain with high-dose radiation. The patient can go home on the same day. However, in this treatment, it may take a few months to a few years for the pain to go away, and permanent numbness may occur in the face half, similar to wig interventions.
Other Surgical Methods: Sometimes, in resistant patients, it may be necessary to cut the nerve where the root of the nerve exits the brain stem with open surgery (Trigeminal DREZotomy) or to cut the nerve where necessary along the course of the nerve (trigeminal neurectomy).