Trigeminal Neuralgia Treatment

Understanding Trigeminal Neuralgia

Trigeminal neuralgia (TN), sometimes called tic douloureux, is considered one of the most painful conditions known to medicine. It causes sudden, severe, electric shock-like facial pain that can be triggered by everyday activities such as eating, talking, brushing teeth, or even a light breeze on the face.

The condition affects the trigeminal nerve, which carries sensation from your face to your brain. In most cases, trigeminal neuralgia is caused by a blood vessel pressing on the trigeminal nerve where it exits the brainstem. This compression damages the nerve's protective coating (myelin), causing it to send abnormal pain signals.

Symptoms of Trigeminal Neuralgia

• Sudden, severe, shooting or stabbing facial pain
• Pain typically affects one side of the face
• Episodes lasting from seconds to several minutes
• Pain triggered by touch, chewing, speaking, or facial movements
• Pain-free periods between attacks (which may shorten over time)
• Pain in areas supplied by the trigeminal nerve: cheek, jaw, teeth, gums, lips, or eye

Treatment Options

Medication Management

The first line of treatment is typically anticonvulsant medications such as carbamazepine (Tegretol) or oxcarbazepine (Trileptal). These medications can be very effective initially, but many patients find they become less effective over time or cause intolerable side effects.

Microvascular Decompression (MVD)

MVD is considered the gold standard surgical treatment for trigeminal neuralgia. During this procedure, I make a small opening behind the ear to access the trigeminal nerve at the brainstem. The offending blood vessel is identified and a small Teflon cushion is placed between the vessel and nerve, relieving the compression.

MVD offers the highest rates of long-term pain relief (approximately 80-90% of patients experience significant improvement) and the lowest rates of facial numbness compared to other surgical options. My fellowship training in skull base and cerebrovascular surgery provides the technical expertise needed for safe, effective MVD surgery.

Stereotactic Radiosurgery

For patients who are not candidates for open surgery or prefer a less invasive approach, stereotactic radiosurgery (e.g., ZAP-X) offers another option. This treatment delivers a focused dose of radiation to the trigeminal nerve root. Pain relief typically develops over several weeks to months. While less invasive than MVD, radiosurgery has somewhat lower long-term success rates and higher rates of facial numbness.

Percutaneous Procedures

Several minimally invasive procedures can be performed through a needle inserted through the cheek, including radiofrequency ablation, balloon compression, and glycerol injection. These procedures intentionally damage the nerve to interrupt pain signals. They may be appropriate for patients who cannot tolerate general anesthesia or have recurrent pain after other treatments.

Choosing the Right Treatment

The best treatment for your trigeminal neuralgia depends on several factors:

• Your age and overall health
• The specific cause of your TN (vascular compression vs. other causes)
• Previous treatments and their results
• Your preferences regarding potential benefits and risks

I take time to thoroughly discuss all options with each patient, ensuring you understand the pros and cons of each approach before making a decision together.

Why Choose Dr. Walcott?

• Skull Base Expertise: Fellowship training at UCSF and Massachusetts General Hospital
• Comprehensive Options: Trained in microsurgery, radiosurgery, and medical management
• Harvard Foundation: Residency at Massachusetts General Hospital
• Patient-Centered Care: Dedicated to finding the right solution for each individual