Trigeminal Neuralgia

Treatment

At Mayo Clinic, dedicated specialists from the Departments of Neurology and Neurosurgery have years of experience treating patients with trigeminal neuralgia. Treatment programs are tailored to each patient to reduce the frequency and intensity of pain episodes and improve quality of life.

Several treatment options are available, including medication, surgery and a combination of the two.

Medication

Anticonvulsant Drugs

Anticonvulsant drugs, originally developed to treat seizures, have also been very effective in treating trigeminal neuralgia. For the majority of patients in the early stages of the disease, anticonvulsant drugs control pain. The medication's effectiveness may decrease over time, however, and side effects may include dizziness, double vision, sleepiness and nausea.

Muscle Relaxants

Muscle relaxants may be more effective when used in combination with anticonvulsant medications. Side effects may include confusion, depression and severe drowsiness.

Trigeminal neuralgia often follows a remitting-and-relapsing course in which some patients experience pain, control the pain with medication, and then, after weeks or months, are weaned off the medication and remain pain-free.

Surgery

Although some patients get adequate pain control through medication, others eventually stop responding to medication, or they experience side effects.

For these patients, surgery — or a combination of surgery and medication — may be an option. The goal of surgery for trigeminal neuralgia is to either damage or destroy the part of the trigeminal nerve that is the source of the pain. Because the success of the procedure depends on damaging the nerve, one side effect is facial numbness of varying degrees.

Alcohol Injection

Injection of alcohol beneath the skin around the branches of the trigeminal nerve may offer temporary relief by numbing the areas for days or months. Because pain relief is not always permanent, injections may be repeated as needed.

Glycerol Injection

In percutaneous (through the skin) glycerol rhizotomy (PGR), a needle is inserted into the trigeminal nerve where the nerve exits the base of the skull. During the procedure, X-rays are taken to confirm that the needle is in the proper location. Once the location is confirmed, a small amount of sterile glycerol is injected. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals.

Initially, PGR relieves pain in most people. Pain recurs for many patients, however, and many experience mild facial numbness or tingling.

Balloon Compression

In percutaneous balloon compression of the trigeminal nerve (PBCTN), a needle is inserted through the face and into the hole at the base of the skull where the trigeminal nerve exits. A catheter (a thin, flexible tube) with a balloon on its end is threaded through the needle. The balloon is inflated with enough pressure to compress the nerve, blocking the pain signals.

PBCTN successfully controls pain in most patients. However, most patients undergoing PBCTN experience varying degrees of facial numbness, and some often have temporary weakness in the muscles used for chewing.

Electric Current

Percutaneous stereotactic radiofrequency thermal rhizotomy (PSR) selectively destroys nerve fibers associated with pain. A needle is inserted through the face and into the opening in the skull for the trigeminal nerve. Once the needle is in place, an electrode is threaded through the needle until the electrode rests against the nerve root. The electrode's position is verified by electrically stimulating the trigeminal nerve. A current is passed through the tip of the electrode until it is heated to the desired temperature for about 70 seconds. The heated electrode damages the nerve fibers and creates an area of injury (lesion). If the pain is not eliminated, additional lesions may be created.

PSR successfully controls pain in most people. A common side effect of this treatment is facial numbness ranging from mild to severe. As with other percutaneous procedures, pain may recur after months or years. The procedure may be repeated as necessary.

Stereotactic Radiosurgery

Stereotactic radiosurgery delivers single doses of radiation to the root of the trigeminal nerve to damage the nerve and eliminate the pain. Stereotactic radiosurgery is painless and typically is done without anesthesia. This procedure successfully eliminates pain more than half of the time. However, between three weeks and three months might be required for pain relief to begin. Read more about stereotactic radiosurgery.

Surgical positioning and approach for microvascular decompression

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Microvascular Decompression (MVD)

Blood vessels that have contact with the trigeminal nerve root where it leaves the brain stem are relocated or removed. Microvascular decompression (MVD) does not damage or destroy any part of the trigeminal nerve.

Microvascular decompression is a major surgical procedure performed in an operating room. The patient receives general anesthesia. A small incision is made behind the ear and, with the aid of a microscope, the trigeminal nerve is directly inspected through a small opening in the skull. If an artery is in contact with the nerve root, the surgeon directs it away from the nerve and places a small Teflon® pad between the nerve and the artery to prevent contact with the nerve.

Commonly, two to three days in the hospital are required following MVD. Most patients who have this procedure performed by qualified Mayo neurosurgeons have no facial numbness and are pain-free, requiring no further medications. The pain relief is usually instant.

MVD has a high success rate but also carries risks, including a small chance of decreased hearing, facial weakness or numbness, double vision, and even stroke or death.