Trigeminal Neuralgia: Understanding Your Options

Trigeminal Neuralgia (TN) is a chronic pain disorder affecting the fifth cranial nerve. Typical TN (TN1) is characterized by attacks of intense, stabbing pain affecting the mouth, cheek, nose, and/or other areas on one side of the face. Atypical TN (TN2) is characterized by less intense, but constant dull aching or burning pain.

It is important that you understand all your treatment options before making a decision with your healthcare providers. Treatments differ primarily in their technical nature and potential side effects. Patients should discuss the risks and benefits of each option with their care team.

The most common treatment options for trigeminal neuralgia include, but are not limited to, the following:

Medication
Treatment with medication is used to slow the nerve’s ability to produce pain signals. Medication types include anticonvulsants, nerve pain and migraine relief, and sedatives. Side effects include tiredness, dizziness, memory problems, confusion, double vision, leukopenia, unsteadiness, nausea/vomiting, and allergic skin reactions. This method requires a long-term treatment plan to be effective.

Glycerol Injection
Injecting glycerol into the trigeminal nerve blocks the neurons from producing pain by destroying the nerve fibers. During the procedure, the patient is sedated under local anesthesia. Side effects may include bleeding, infection, nausea/vomiting. The success of this procedure depends on the preoperative degree of pain and postoperative degree of numbness. Once the nerve regenerates, the pain will likely return, at which point the procedure may need to be repeated.

Balloon Compression
Percutaneous trigeminal ganglion balloon compression (PCB) selectively injures the large myelin fibers that mediate touch by injecting a small balloon into the nerve using a needle catheter while the patient is under general anesthesia. It reduces the sensory input, thus reducing pain. It does not injure the small unmyelinated fibers that control pain and
temperature sensation. Complications may include severe numbness, abnormal sensation, and masseter weakness.

Microvascular Decompression
Microvascular decompression openly removes the blood vessels creating pressure on the trigeminal nerve. This involves an incision behind the ear. If completely removing the blood vessels is not necessary, a small pad may be inserted in between them and the nerve to prevent contact.

Gamma Knife
The Gamma Knife is a radiosurgical option to treating trigeminal neuralgia. It uses highly-focused beams of radiation to alter the fibers in the nerves which produce pain. It requires a rigid frame to immobilize the patient’s head during treatment. Side effects may include light tingling or numbness in the face.

CyberKnife
Much like the Gamma Knife, the CyberKnife uses radiation to the trigeminal nerve. The CyberKnife is a safe and effective system, able to target the nerve with pinpoint sub-millimeter accuracy without the use of a screwed-in headframe. The CyberKnife treatment process is noninvasive and pain-free and can be completed in one treatment. The patient is immediately able to return to normal activities without any hospital stay, anesthesia, or numbness.

St. Louis CyberKnife offers trigeminal neuralgia treatment using the CyberKnife Robotic Radiosurgery System. This is a one-time treatment proven beneficial to TN patients. To learn more or schedule a consultation, contact us.