What is trigeminal neuralgia surgery?
Trigeminal neuralgia is a severe form of facial nerve pain. The surgery to decompress the nerve is not technically brain surgery, but the surgeon must open the skull to perform it.
Trigeminal neuralgia surgery is a treatment for nerve pain (neuralgia) that is caused by the trigeminal nerve. The trigeminal nerve exits the brain directly through the skull to supply sensation to the face. The procedure frees the trapped nerve and stops the transmission of pain signals from the trigeminal nerve to the brain.
Trigeminal neuralgia, also known as tic douloureux, is a type of severe nerve pain in the forehead, cheek, teeth and jaw, usually affecting one side of the face.
Types of trigeminal neuralgia treatments
- Microvascular decompression: This procedure is an open surgery in which the surgeon makes a small opening in the skull (craniotomy) and places a Teflon sponge between the trigeminal nerve and the impinging blood vessel.
- Percutaneous procedures: These procedures are minimally invasive and involve insertion of a needle into the bundle of nerves where the three branches of the trigeminal nerve join (Gasserian ganglion). There are three kinds of percutaneous procedures:
- Percutaneous radiofrequency trigeminal gangliolysis (PRTG) or radiofrequency rhizotomy: An electric current is passed through the needle, producing a thermal lesion in the Gasserian ganglion and disrupting the pain signals.
- Percutaneous balloon decompression (PBM): A balloon is inserted and inflated in the Gasserian ganglion for up to 10 minutes to damage it and block the pain signals.
- Percutaneous retrogasserian glycerol rhizotomy (PRGR): Glycerol is injected to destroy the pain transmitting nerve fibers in the Gasserian ganglion.
- Gamma Knife surgery: Also known as stereotactic brain radiosurgery, this procedure is the least invasive. The Gamma Knife delivers precise, controlled beams of radiation to the trigeminal nerve where it connects to the brain stem and thereby directly stops the pain signal transmission.
Is trigeminal neuralgia surgery brain surgery?
Trigeminal neuralgia surgery is not a brain surgery as it does not affect the brain. Microvascular decompression surgery involves making an opening in the skull and the membrane (dura) covering the brain, to access the trigeminal nerve. The brain itself is untouched during the surgery. The percutaneous procedures are minimally invasive with only a needle insertion directly in the nerve, while Gamma Knife surgery is a targeted delivery of radiation to the nerve.
Why is a trigeminal neuralgia surgery performed?
The trigeminal nerve is the cranial nerve responsible for sensations in the face and motor functions like biting and chewing. The trigeminal nerve has three main branches on each side of the face, sending and receiving signals between the brain and the facial tissues.
When the trigeminal nerve is irritated, it can result in trigeminal neuralgia that can be debilitating. A blood vessel pressing on the trigeminal nerve is the most common cause of trigeminal neuralgia.
Other causes of the trigeminal nerve compression include
Trigeminal neuralgia may be
- Typical: sudden, unpredictable attacks of stabbing, electric shock-like pain in a consistent location, usually caused by a trigger such as touching the face, chewing or talking.
- Atypical: persistent dull ache or burning sensation in one side of the face, with or without episodes of sharp pain, without any triggers.
Without treatment, typical trigeminal neuralgia can progress to the atypical kind. Trigeminal neuralgia usually worsens over time, with periods of remission between the episodes becoming shorter. For many people, medications lose efficacy over time and increase in dosage comes with complications of the drug side effects.
Trigeminal neuralgia surgery is performed when
- Medications are not effective in controlling the pain
- Patients are intolerant to medications
- Other previous treatment procedures have failed