Facial Pain Treatment, Treatment Options for Trigeminal Neuralgia

Hello, I’m Dr. Steven Bailey, and I am a
neurosurgeon with Mayfield Brain & Spine. I would like to talk to you today about trigeminal
neuralgia, a pain syndrome that can be terribly disruptive of people’s lives. I became interested in treating trigeminal
neuralgia during my training at the Medical University of South Carolina and at Mayfield
Clinic. Both programs treat a great many patients
with trigeminal neuralgia, and I experienced real satisfaction from helping people recover
from this very painful condition. Trigeminal neuralgia is an inflammation of the trigeminal nerve, which supports sensation in the face. The condition typically affects one side of
the face, and it can occur anywhere from the jaw to the forehead to the area around the
eye. It typically begins with brief but very intense
shocking sensations, which can be triggered by pretty innocuous activities of daily living,
such as brushing one’s teeth, chewing, talking, or a draft of cold air that is hitting the
face. Trigeminal neuralgia can be completely debilitating. We see people who can no longer work, who
can’t carry out normal activities, who have difficulty shaving, eating or washing their
face because of the pain. Trigeminal neuralgia can be associated with
a few diseases, such as multiple sclerosis, but in most cases it is idiopathic, which means that it simply develops without known cause. It is possible, though not proven, that genetics
play a role in the origin of TN. During the early stages, trigeminal neuralgia
can be managed with medications. But as time goes on, the medications can lose
their effectiveness. At Mayfield, we treat patients whose trigeminal
pain is no longer controlled by medications in one of three ways. The first treatment is called a microvascular
decompression, or MVD. An MVD is a form of open surgery, in which
an opening called a craniotomy is cut into the bony skull. This exposes the trigeminal nerve where it
leaves the brainstem. During this procedure, we look for a blood
vessel that may be compressing or sitting on the nerve and causing pain. We then separate the blood vessel from the
nerve and insert a cushion. The procedure is performed in the hospital,
and the patient remains in the hospital several nights. The second treatment is called a percutaneous
stereotactic radiofrequency rhizotomy. This is a more minimally invasive treatment,
and it is performed at the Mayfield outpatient surgery center. During the procedure, I place an electrode
through the skin of the cheek and into the nerve. Our goal is to cause some controlled damage to the portion of nerve that is involved in the distribution of pain. Patients who undergo a PSR go home the same day. The third treatment involves radiation. The goal of radiation treatment is to damage
the trigeminal nerve root to interrupt the pain signals and keep them from reaching the
brain. Stereotactic radiosurgery is a noninvasive
outpatient procedure that uses highly focused radiation beams to destroy some of the trigeminal
nerve fibers that produce pain. Radiosurgery is delivered by systems such
as Leksell Gamma Knife or a linear accelerator system such as the BrainLab Novalis. A stereotactic head frame or facemask is attached
to the patient’s head to precisely target the nerve and to hold the head still during
treatment. Highly focused beams of radiation are delivered
to the trigeminal nerve root over a period of about an hour. Pain relief may not occur immediately but
rather gradually over time. A majority of patients will eventually experience
improvement of their symptoms, although some may need to continue taking pain medication. Many patients are candidates for more than
one type of procedure, so we take several things into consideration. These include previous treatments, any additional
health conditions the patient has, and — certainly, the patient’s preference. Oftentimes the hardest part of this condition
is receiving the correct diagnosis and getting to the people who are able to help you. Once patients get to the right clinical practice, like Mayfield, their trigeminal pain is quite treatable. When I see patients with trigeminal neuralgia,
their biggest concern is usually, “How quickly can I get relief?” I tell them that their condition is a priority,
and we will expedite their care as quickly as possible so that they can get back to enjoying
life and doing all of the things they did before. I hope this has answered your questions about
how we treat trigeminal neuralgia at Mayfield. To learn more, please visit us at mayfieldclinic.com.

About the Author: Earl Hamill

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