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Trigeminal Neuralgia Treatments

While extremely painful, trigeminal neuralgia is not life threatening.  Consequently, the goal of trigeminal neuralgia treatment is to relieve or minimize the pain, whether that treatment involves medication, injections or surgery.

Trigeminal neuralgia treatment usually starts with medication that can reduce or block the pain signals sent from trigeminal branches (sensory nerves of the face) to the brain.  An antiseizure medication, or anticonvulsant, is the drug most commonly prescribed to suppress excessive nerve activity that causes pain.  Common side effects may include dizziness, confusion, drowsiness, double vision and nausea.  If the medication is ineffective or loses its effectiveness over time, or if the side effects can’t be tolerated, other options are available.

Nerve blocks using local anesthetics can be injected into the trigger area or pain site for temporary relief, while alcohol injections can also provide temporary pain relief by numbing the affected areas of your face.  Because pain relief isn't permanent, repeated injections or a different procedure may be required in the future.  Side effects may include infections, bleeding and damage to nearby nerves.

Injection of glycerol around the gasserian(trigeminal) ganglion can damage the fibers that conduct triggering impulses. Under general anesthesia or following intravenous sedation, a small amount of glycerol is injected into the chamber housing the nerve ganglion at the base of the skull.  While the initial success rate is very high and most patients experience immediate pain relief, the chance of recurrence is increases over time.  Additional injections may be performed, but glycerol injections typically become less effective after several have been performed.

The goal of surgery for trigeminal neuralgia is to relieve pressure on the nerve or reduce nerve sensitivity by moving the blood vessel away from the trigeminal nerve.

Microvascular decompression is the most commonly used surgical treatment for trigeminal neuralgia for healthy people who are looking for the most durable, least damaging procedure.  It relieves trigeminal neuralgia by placing a small pad between the trigeminal nerve and the blood vessels next to the nerve.  In other words, the surgeon moves or repositions the compressing artery to a location away from the compressed root of the nerve.  More than 80% of patients enjoy long-term pain relief and with normal sensation in the face.  Serious complications are rare and there is a lower chance of recurrence of the pain.

Gamma-knife radiosurgery delivers a high dose of radiation to the root of the trigeminal nerve to damage the nerve and reduce or eliminate pain.  Radiofrequency treatments relieve trigeminal neuralgia by damaging or destroying trigeminal nerve cells.

Princeton Brain & Spine Care surgeon Mark McLaughlin, M.D. trained with Peter Jannetta, M.D., the "father" of modern microvascular decompression surgery for trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, and other cranial nerve rhizopathies. Dr. McLaughlin worked closely with Dr. Jannetta in the ongoing research, and was the lead author of the paper "Microvascular decompression of cranial nerves: lessons learned after 4400 operations" published in the Journal of Neurosurgery in January 1999. On PUBMED

Trigemenal and Occipital Neuralgia

LastUpdate: 2016-05-11 17:19:06


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