Trigeminal Neuralgia

Trigeminal Neuralgia

What is trigeminal neuralgia?

Trigeminal Neuralgia is a condition which causes intense, stabbing, electric shock-like pain mainly in the lower face and jaw, sometimes affecting the area around the nose and above the eye. Usually involves one side of the face. Pain is more severe and an intense, that sometimes, it is described as most excruciating pain known to humanity

What are the causes of trigeminal neuralgia?

It is caused by irritation of the trigeminal nerve. Trigeminal nerves are a set of cranial nerves which provides sensory as well as motor supply to muscles in the face. Causes of trigeminal neuralgia can be primary or secondary.

What are the signs and symptoms of trigeminal neuralgia?

Pain is typically intense, sharp, throbbing or a shock like pain in one side of the face. Attacks of pain can be triggered by touching the face gently, washing, brushing teeth, smiling or even by a light breeze over the face

Pain is the characteristic feature of Trigeminal Neuralgia. Trigeminal Neuralgia tends to run in cycles. Patients often suffer long stretches of frequent attacks, followed by long gaps without pain. The usual pattern is for the attacks to intensify over time with shorter pain free intervals. Some patients may suffer less than one attack per day while some experience a dozen or more every hour. It begins with a sensation of electric shock that becomes excruciating stabbing pain within less than 20 seconds.

Most of the patients mistake Trigeminal Neuralgia for dental pain. It is not uncommon to see patients have a root canal dental procedure performed already before reaching Neurosurgeon.

How to diagnose trigeminal neuralgia?

Diagnosis can be made clinically with the typical pain history and its response to medications like carbamazepine. A high resolution MRI Brain is usually done to confirm the Neurovascular conflict or any condition which causes Trigeminal Neuralgia

How is this condition treated?

Initially Trigeminal Neuralgia is treated with medications. If a patient is not tolerating medications because of side effects or if there is no adequate pain relief then it should be managed surgically.

What are the surgeries done for trigeminal neuralgia?

Surgical treatment for Trigeminal Neuralgia can be divided into two categories

Open Micro neurosurgery: It involves craniotomy, microsurgical exposure of trigeminal nerve roots and decompressing it from the compressing blood vessel by usually keeping a Teflon patch between them. It is the most definite method of treatment in trigeminal neuralgia Lesioning procedures: These are usually minimally invasive procedures which avoids craniotomy in selected patients. Percutaneous Radiofrequency ablation, percutaneous glycerol rhizotomy, stereotactic radiosurgery are some examples. Overall, the risks and benefits should be weighed carefully and treatment must be tailored for each patient.