neurology

What Is the Recovery Time for Trigeminal Neuralgia Surgery?

July 19, 2021

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What is trigeminal neuralgia surgery?

Trigeminal neuralgia surgery is a procedure to decompress the trigeminal nerve that may cause pain and discomfort in the face.

Trigeminal neuralgia surgery is a treatment for facial nerve pain (neuralgia) that is caused by irritation in the trigeminal nerve. The trigeminal nerve has three main branches on each side of the face, which combine as a bundle of nerves (Gasserian ganglion). Trigeminal neuralgia surgery is performed to eliminate the irritation in the nerve when medications are not effective.

Surgical treatment for trigeminal neuralgia is of three types:

Microvascular decompression
Percutaneous procedures
Gamma knife surgery

Microvascular decompression (MVD) procedure

MVD is an open surgery performed by a neurosurgeon with the patient under general anesthesia.

Preparation

The patient may be required to

Undergo blood tests.
Undergo magnetic resonance imaging (MRI) and/or magnetic resonance angiogram (MRA) of the brain to evaluate blood vessel malformation or blood vessel impingement on the trigeminal nerve.
Avoid eating and drinking for eight hours prior to the procedure.
Check with the doctor before taking any regular medication.
Inform the doctor of any allergies.

Procedure

The anesthesiologist

Attaches an IV line and administers general anesthesia.
The anesthesiologist monitors the patient’s vital signs during the procedure.

The neurosurgeon

Makes an incision in the skin behind the ear.
Makes a 3-cm opening in the skull (craniotomy).
Opens and retracts the brain’s membrane (dura) to access the trigeminal nerve.
Moves the blood vessel and releases the trapped trigeminal nerve.
Places a Teflon sponge between the nerve and the blood vessel.
May also cut or destroy a part of the trigeminal neve.
Closes the dura with sutures and applies a surgical glue to prevent leakage of cerebrospinal fluid (CSF).
May replace the bone piece using surgical glue or use a titanium plate to close the hole in the bone.
Closes the incision with sutures.

Post-surgery

The patient’s vital signs are monitored in the recovery room.
The patient is weaned off the anesthesia and administered painkillers.

Percutaneous trigeminal neuralgia procedures

Percutaneous procedures are usually performed by pain management specialists as an outpatient procedure, using local anesthesia and mild sedation or brief general anesthesia.

The patient undergoes blood tests and MRI.
The doctor inserts a needle lateral to the corner of the mouth into the Gasserian ganglion, with the guidance of continuous X-ray (fluoroscopy).
The doctor may perform one of the following:
- Pass an electric current through the needle and produce a thermal lesion with the heat, disrupting the pain signals (Percutaneous radiofrequency trigeminal gangliolysis [PRTG] or radiofrequency rhizotomy).
- Insert a balloon and inflate it for up to 10 minutes to damage the Gasserian ganglion and block the pain signals (Percutaneous balloon decompression [PBM]).
- Inject glycerol to destroy the nerve’s pain fibers (Percutaneous retrogasserian glycerol rhizotomy [PRGR]).
The doctor withdraws the needle and applies a bandage.
The patient can leave for home the same day.

QUESTION

Medically speaking, the term “myalgia” refers to what type of pain?
See Answer

Gamma knife surgery for trigeminal neuralgia

Radiation therapists perform the Gamma Knife therapy as an outpatient procedure.
A frame is fixed to the head with four pins to keep the head immobile.
A local anesthetic is used at the pin site.
The radiologist uses stereotactic MRI for targeting the precise location of the trigeminal nerve where it connects to the brain stem.
The radiologist uses the Gamma Knife device to deliver controlled beams of radiation on the point where the trigeminal nerve connects to the brain stem, to block the transmission of pain signals.