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If you’ve experienced the intense pain associated with trigeminal neuralgia for some time, you are undoubtedly wondering what can be done, beyond medications, to ease your suffering. For patients questioning what is the best treatment for trigeminal neuralgia, doctors typically offer one of four options: microvascular decompression (MVD), Gamma Knife radiosurgery, percutaneous rhizotomy and pain stimulator placement. The intervention appropriate for you depends on your age and general health. Below is a discussion that will help you become familiar with the different treatment options for trigeminal neuralgia.

Microvascular Decompression (MVD)

The most effective of all the surgical treatments for trigeminal neuralgia, microvascular decompression (MVD) is performed in a hospital, under general anesthesia, by a sub-specialized neurosurgical team.  As such, MVD requires a hospital stay of anywhere between 1-3 days.  During the procedure, your neurosurgeon will make a small opening in the skull behind your ear.  Next, the neurosurgeon will move away any blood vessel touching your trigeminal nerve and place one or more Teflon pads between the artery (or vein) and the trigeminal nerve. This is done with the intent and hope that your nerve will return to a pain-free condition, often immediately.

By nature, surgery of this type carries a small percentage risk of bleeding, infection, and cranial nerve damage.  Complications, although rare in experienced hands, can include diminished hearing, skin infection, and leakage of cerebrospinal fluid.  However, research and experience have shown that MVD surgery is also the most effective treatment for appropriately selected patients.  MVD surgery also has the lowest recurrence rates and is the most effective surgical intervention at helping patients get off of medications.

Gamma Knife Radiosurgery (GKRS)

Also called stereotactic radiosurgery, Gamma Knife radiosurgery (GKRS) is an intervention that delivers multiple radiation beams to the root of the trigeminal nerve. This approach will result in the slow formation of a lesion on your nerve that should stop the transmission of pain signals to your brain. After undergoing this procedure pain relief won’t be immediate but should develop over a period of weeks or sometimes months. According to the International Radiosurgery Association, 50 to 78 percent of trigeminal neuralgia patients who undergo Gamma Knife radiosurgery experience excellent pain reduction within a few weeks. If your pain reoccurs, the procedure may be repeated.

Since no cutting is required in Gamma Knife radiosurgery, the procedural risks are quite low. Early side effects are usually temporary and may include fatigue, headache and nausea in addition to scalp swelling and sensitivity.  A major advantage of GKRS is that it is performed as an outpatient and does not require a hospital stay or stopping of any medications (such as coumadin, aspirin, or plavix).

Percutaneous Rhizotomy

In a percutaneous rhizotomy, the medical team will use different agents to damage part of your trigeminal nerve, which should block pain signals to your brain. The intervention consists of passing a hollow needle through your cheek and guiding it to your trigeminal nerve. Then, heat, a sterile glycerol injection or balloon compression will be used to injure the fibers that are causing you the pain. Some degree of sensory loss and facial numbness is associated with this method.

Pain Stimulator Placement

The deliverance of tiny electrical impulses to the nerve is the means by which stimulator placement is used to ease pain. When you undergo this procedure, you’ll receive a shot of a local anesthetic to numb your face. Your surgeon will then insert a small electrode under your skin and connect it to an external stimulator.

At this point, a trial period begins to determine if the treatment proves successful in alleviating your pain. This trial usually starts with an overnight hospital stay, after which you’ll be released with instructions on how to use the device at home. For the remainder of the trial, you’ll monitor the effectiveness of the stimulator. If it works well, your surgeon will replace the temporary implant with a permanent connection to an electrode.

Choosing the Best Treatment for Trigeminal Neuralgia

If you have facial pain, make an appointment with an expert neurosurgeon to get a correct diagnosis. Your doctor will most likely try to manage your condition with the first-line medications including Tegretol and/or Trileptal. If you’re unable to tolerate these drugs or if they don’t give adequate pain relief, the next step should be to consider other treatment options.

For people with classic trigeminal neuralgia that no longer responds to medications and the finding of a blood vessel compressing the trigeminal nerve (on MRI), microvascular decompression is most often the best choice, provided they are healthy enough to undergo general anesthesia. When patients aren’t good candidates for that treatment, the next best intervention is Gamma Knife radiosurgery. If this option fails to produce good results, percutaneous rhizotomy or pain stimulators are usually considered.

Conclusion

The answer to the question, “What is the best treatment for trigeminal neuralgia?” depends on many variables. Your doctor can evaluate you and advise the treatment that would most optimally suit your needs. Fortunately, the four treatment options for trigeminal neuralgia — microvascular decompression, Gamma Knife radiosurgery, percutaneous rhizotomy and pain stimulator placement — make it possible for many people to receive relief from their suffering. Whether you undergo a procedure that immediately removes the pain or one that reduces it gradually, you have a reasonably good likelihood of receiving much benefit.Neurosurgeons Consultation NJ