Trigeminal Neuralgia

Trigeminal Nerve

The trigeminal nerve, which is divided into three branches, is responsible for chewing, for producing saliva and tears, and for sending facial sensations to the brain. When this nerve breaks down for some reason, it can trigger brief but agonizing sizzles of pain on one side of the face. This condition is unusual in those under age 50 and more often occurs after 70. Women are three times more likely to have the condition than are men.

Trigeminal Neuralgia

Trigeminal neuralgia is a disorder of the trigeminal nerve (the fifth cranial nerve) that causes episodes of sharp, stabbing pain in the cheek, lips, gums, or chin on one side of the face.

Causes

Trigeminal neuralgia is usually caused by a blood vessel pressing on the nerve inside the skull. Less commonly, multiple sclerosis or a tumor can cause trigeminal neuralgia. In many cases, however, there is no apparent cause.

Symptoms:

Occasional twinges of mild pain
Episodes of severe, shooting or jabbing pain that may feel like an electric shock
Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking and brushing teeth
Bouts of pain lasting from a few seconds to several seconds
Episodes of several attacks lasting days, weeks, months or longer — some people have periods when they experience no pain
Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead
Pain affecting one side of your face at a time
Pain focused in one spot or spread in a wider pattern
Attacks becoming more frequent and intense over time

Treatment:

Micro Vascular Decompression:
This procedure involves relocating or removing blood vessels that are in contact with the trigeminal root. During micro vascular decompression, your doctor makes an incision behind the ear on the side of your pain. Then, through a small hole in your skull, your surgeon moves any arteries that are in contact with the trigeminal nerve away from the nerve, and places a pad between the nerve and the arteries. If a vein is compressing the nerve, your surgeon may remove it. Doctors also may cut part of the trigeminal nerve (neurectomy) during this procedure, if arteries aren’t pressing on the nerve.
Gamma Knife Radio Surgery:
In this procedure, a surgeon directs a focused dose of radiation to the root of your trigeminal nerve. This procedure uses radiation to damage the trigeminal nerve and reduce or eliminate pain. Relief occurs gradually and may take several weeks. Gamma Knife radiosurgery is successful in eliminating pain for the majority of people. If pain recurs, the procedure can be repeated. Because Gamma Knife radio surgery is effective and safe compared with other surgical options, it is becoming widely used and may be offered instead of other surgical procedures.
Balloon Compression:
In balloon compression, your doctor inserts a hollow needle through your face and guides it to a part of your trigeminal nerve that goes through the base of your skull. Then, your doctor threads a thin, flexible tube (catheter) with a balloon on the end through the needle. Your doctor inflates the balloon with enough pressure to damage the trigeminal nerve and block pain signals.
Glycerol Injection:
During this procedure, your doctor inserts a needle through your face and into an opening in the base of your skull. Your doctor guides the needle into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion — where the trigeminal nerve divides into three branches — and part of its root. Doctors inject a small amount of sterile glycerol, which damages the trigeminal nerve and blocks pain signals. This procedure often relieves pain. However, some people have a later recurrence of pain, and many experience facial numbness or tingling.

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