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Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a nerve disorder that causes facial pain. This pain is often only on one side of the face, around the eye, cheek, and lower part of the face.

There are 12 nerves in the skull. These are called cranial nerves. The trigeminal nerve is the largest of these nerves. The trigeminal nerve has fibers inside that carry sensation. On the outside of the nerve is a lining called the myelin sheath.

Sometimes there’s a problem with these inner fibers or with the myelin sheath. When that happens on the trigeminal nerve, the condition is trigeminal neuralgia. This condition can affect anyone at any age, but is usually found in older adults. Trigeminal neuralgia may be caused by multiple sclerosis or a swollen blood vessel or tumor, but often there is no cause found.

Diagnosis

Diagnosis is often based on a patient’s history, and can include:

• Description of symptoms
• Physical exam
• Neurological exam
• MRI or MRA scans

Symptoms

The pain is described as sharp, similar to an electrical shock. It may last for seconds or minutes, but can become constant.

Triggers

The pain can be triggered by anything you do to your face: brushing your teeth, applying makeup, etc. Even a breeze on your face can trigger pain.

Treatment

Medicine is often used to control pain. Among other treatment options are:

Microvascular Decompression: This is an operation where the surgeon enters the skull and puts a small pad between the trigeminal nerve and the blood vessel next to the nerve. This procedure is the most invasive choice, but it offers the lowest risk that the pain will return.

Stereotactic Radiosurgery (aka Gamma Knife): Radiosurgery aims finely focused beams of radiation at a problem site inside the brain. The target could be a tumor, or the trigeminal nerve itself. If it is a tumor, the radiation can weaken it. In some cases, this procedure can actually shrink a tumor. If it isn’t a tumor, the radiation can stop pain signals from getting to the brain.

This procedure is the least invasive, and takes about 30 minutes to 1 hour. Some patients may need more than one treatment session. There are risks; radiosurgery may damage tissue around the target area.

Percutaneous Stereotactic Radiofrequency Lesion Procedure (RFL): This option destroys the trigeminal nerve with a heated needle.

This is done in an operating room and involves several steps:

1.     A needle is put into the cheek through a small, natural hole in the base of the skull, reaching the trigeminal nerve.

2.     The patient is put to sleep while the needle is put in.

3.     The patient wakes up while a small electrical current goes through the needle. This should cause tingling where the facial pain is.

4.     The patient is put asleep again. The radiofrequency current is passed through the needle to cause a lesion on the nerve.

5.     The patient wakes up again to see if the pain is gone. If not, the process is repeated.

The patient can often go home the same day.

Balloon Rhizotomy: This procedure is similar to RFL, but it damages the nerve with a small balloon instead of a heated needle. Most people who get this procedure have numbness in the face, and some have temporary or permanent weakness in the chewing muscles.

Related Links

Vanderbilt Skull Base Center

Vanderbilt Clinical Neurosciences

National Institutes of Health guide to Trigeminal Neuralgia

The Facial Pain Association