End Your Facial Pain Once and For All

Trigeminal neuralgia (TGN) causes intense, electric-shock-like facial pain along the trigeminal nerve. If medications or injections haven’t provided lasting relief, surgery might be your next step toward reducing or eliminating pain and getting back to a normal life.

What Is Trigeminal Neuralgia Surgery?

Surgery for trigeminal neuralgia works in one of two ways: it either relieves pressure on the trigeminal nerve or disrupts the pain signals the nerve sends. The goal is straightforward: long-term pain relief with risks that match your specific situation.

Common Surgical Options

Microvascular Decompression (MVD)

Microvascular decompression is often the most effective surgical treatment for typical trigeminal neuralgia because it addresses what’s actually causing the pain: a blood vessel pressing on your trigeminal nerve. During MVD, your surgeon makes a small incision behind your ear and places a soft pad between the vessel and nerve to relieve the pressure.

Benefits of MVD:

• Addresses the root cause of nerve compression
• High success rate for pain relief
• Lower risk of long-term numbness compared to other procedures

What to Expect:

MVD requires general anesthesia and a brief hospital stay. Your recovery involves gradually returning to your normal activities under your surgeon’s guidance.

Stereotactic Radiosurgery (e.g., Gamma Knife)

Radiosurgery uses focused radiation beams to change how pain signals travel through the trigeminal nerve. While it’s not traditional surgery (there’s no incision), it’s grouped with surgical treatments because it directly targets the nerve. Pain relief typically develops gradually over weeks to months.

Benefits:

• No incision or hospital stay required
• Good option if you can’t tolerate open surgery
• Lower procedural risk

Percutaneous Rhizotomy and Related Procedures

These procedures involve guiding a needle through your cheek to reach the trigeminal nerve. Your surgeon might use glycerol injection, balloon compression, or radiofrequency ablation to selectively damage the nerve fibers that carry pain signals.

Considerations:

• Often done as an outpatient procedure
• Many patients experience rapid pain relief
• You may have some facial numbness or tingling afterward

Pain Stimulator Placement

If other procedures haven’t controlled your pain, nerve stimulation might help. Your surgeon places tiny electrodes near the pain-causing nerve fibers and connects them to a pacemaker-like device that disrupts abnormal pain signals.

Who Is a Candidate for Surgery?

Your surgical evaluation includes a thorough review of your symptoms, medical history, imaging studies such as MRI, and your response to previous treatments. Surgery is typically considered when:

• Pain is severe, frequent, and disrupting your life
• Medications no longer work or cause side effects you can’t tolerate
• Imaging shows structural nerve compression
• You’re healthy enough for anesthesia and the proposed procedure

Preparing for Surgery & Recovery Expectations

Your surgical team will outline what to expect before, during, and after your procedure, including any preparation and your personalized recovery plan. Some procedures require a short hospital stay, while others are outpatient. Pain relief can be immediate or gradual, and your doctor will guide you through activity restrictions and follow-up care.

FAQs

How successful is surgery for trigeminal neuralgia?

Success rates vary by procedure. Microvascular decompression has the highest long-term success rate, with many patients experiencing complete pain relief that lasts for years. Other procedures like radiosurgery and percutaneous rhizotomy also provide significant relief, though pain may return over time in some cases.

Will I have pain after trigeminal neuralgia surgery?

Most patients experience some degree of pain relief after surgery, though the timeline varies. MVD often provides immediate relief, while radiosurgery can take weeks to months to work. Your surgical team will provide pain management strategies during your recovery.

What is the recovery time for trigeminal neuralgia surgery?

Recovery time depends on the procedure. Microvascular decompression typically requires a hospital stay of one to two days, with most patients returning to light activities within two to three weeks. Percutaneous procedures are often outpatient with faster recovery. Radiosurgery has no recovery period since there’s no incision.

Can trigeminal neuralgia come back after surgery?

While surgery provides lasting relief for many patients, trigeminal neuralgia can recur. MVD has the lowest recurrence rate. If pain returns, other treatment options may be considered, including repeat procedures or alternative surgical approaches.

What are the risks of trigeminal neuralgia surgery?

All surgical procedures carry some risk. Potential complications include facial numbness, hearing changes, infection, or bleeding. Your neurosurgeon will discuss the specific risks associated with your recommended procedure during your consultation.

Is trigeminal neuralgia surgery covered by insurance?

Most insurance plans cover medically necessary trigeminal neuralgia surgery. Our insurance specialists can help verify your coverage and coordinate with your insurance company to ensure you understand your benefits before proceeding with treatment.

Why Choose Neurosurgeons of New Jersey?

Our practice specializes in treating trigeminal neuralgia, combining extensive clinical experience with personalized care. We develop surgical treatment plans tailored to give you the best possible outcome: minimizing pain and maximizing your quality of life. Our team supports you throughout the entire process, from insurance coordination to post-surgical recovery.

Authors of this Blog: The Facial Pain Team