SURGICAL TREATMENTS FOR TN AND RELATED FACIAL PAIN CONDITIONS
The anatomy of Trigeminal Neuralgia
While medications provide effective management for many TN patients, medical therapy is often not a permanent solution for this problem. Fortunately for the TN patient there are several neurosurgical procedures that are available if medication no longer provides the desired results.
The dilemma for the TN patient considering surgery is how to select a surgical procedure since there are several modes of surgical intervention available. Procedures vary from nerve blocks/injections, percutaneous surgery (through the cheek), to open skull surgery and pinpoint radiation. Each procedure has certain advantages and disadvantages – ease of the procedure, effectiveness, long-term results, recurrences, complications, etc. There is no one medical or surgical treatment that is effective in all patients. The choice between a procedure done as a one-day or outpatient (e.g., radiofrequency coagulation or glycerol injection) or one requiring several days in the hospital (microvascular decompression) depends on the patient’s preference, physical well-being, previous surgeries, presence of multiple sclerosis, and area of trigeminal nerve involvement (some procedures are particularly indicated when the upper/ophthalmic branch is involved).
Undoubtedly, recommendations by the referring physician and by the neurosurgeon play a strong part in the patient’s decision-making process. Many physicians are strong proponents of specific procedures. TNA is not an advocate for any single mode of treatment, but serves to provide information on the many treatments available so that TN patients can explore all their options in an informed partnership with their physician.
- Microvascular Decompression – (MVD). The operation is performed under general anesthesia where a small opening is made in the back of the skull on the side with the pain. The trigeminal nerve is viewed with a microscope and compressing blood vessels are removed and the nerve is padded with a soft pad (typically shredded Teflon).
- Stereotactic Radiosurgery – Gamma Knife. This procedure requires no incision. Using highly focused beams of radiation, a lesion (an area of controlled damage) is created in the root of the trigeminal nerve.
The nerve isn’t burned as in a laser treatment, but the radiation causes the slow formation of a lesion in the nerve over a period of time to interrupt the pain transmission. Other information links include:
- These procedures show varying degrees of immediate success and periods of long-term relief from pain. Generally, the average overall rate of success is 85% with about 25% of this group having some level of recurrence in 1-5 years. Many patients respond quite well when additional measures are pursued if the initial procedure is not successful or if the pain returns. There is no one procedure that is 100% effective in all cases. Therefore, it is imperative that the TN patient becomes as informed as possible about the surgical options available and understands fully the potential benefits and outcome possibilities of the procedures being considered.