Trigeminal neuralgia results in sudden, severe, painful, stabbing,
or electric-like shock in the face. The trigeminal nerve has three sections, which affect
the forehead and eye region, the cheek, and the jaw, respectively. Blood-vessel compression
of the trigeminal nerve results in trigeminal neuralgia. Pain can be triggered by laughing,
chewing, brushing teeth, talking, wind, or facial touching. It can occur in one or all areas,
usually begins on one side of the face, and affects both sides in about 5 percent of patients.
Trigeminal neuralgia is first treated medically, before surgery is considered. If medication is not
effective, UPMC neurosurgeons usually recommend
Microvascular Decompression. This minimally invasive surgery treats the cause of the problem, offers
the most long-lasting relief, and minimizes risk of postoperative side effects like numbness. UPMC’s high
volume of patients has allowed our surgeons to research treatment effectiveness, making UPMC a world leader
in the management of trigeminal neuralgia.
Atypical trigeminal neuralgia shares characteristics of trigeminal neuralgia. Microvascular decompression may
be indicated in certain cases, but the effectiveness of the treatment for the atypical version of the disorder is less favorable.
Your doctor may ask about any symptoms you are experiencing. Symtoms of trigeminal neuralgia often include sudden, severe, painful, sabbing,
or electric-like shock in the face.
Because similar symptoms can occur due to a tumor, arteriovenous malformation, or multiple sclerosis, an MRI scan with and without an injected contrast dye is essential to diagnosis.
Medications
Trigeminal neuralgia is first treated with anticonvulsant drugs, and doctors may prescribe other medications as well. In many cases, patients are not helped by these medications, experience breakthrough pain, or suffer undesirable side effects. In such cases, UPMC surgeons usually recommend Microvascular Decompression.
Surgery
Microvascular Decompression is a minimally invasive surgical procedure using endoscopes that treats the cause of the problem, offers the most long-lasting relief, and minimizes risk of postoperative side effects like numbness.
Microvascular Decompression relieves abnormal compression of a cranial nerve. The surgery consists of a linear incision behind the ear followed by a craniectomy (bony opening) the size of a silver dollar. Under the view of a microscope or endoscope, the surgeons detect the area where the blood vessel is affecting the nerve and then separate them, leaving a Teflon "pillow" in between.
Each year, more than 500 patients with trigeminal neuralgia are treated at UPMC, including about 100 who undergo microvascular decompression. This high volume of patients has allowed surgeons here to pursue research aimed at improving treatment effectiveness, making UPMC a world leader in the management of trigeminal neuralgia.
In the last 25 years, UPMC neurosurgeons have treated more than 20,000 patients with trigeminal neuralgia. Treatment provides immediate, complete relief in 82 percent of cases, with an additional 16 percent achieving partial relief and requiring occasional or low-dose medication. One year after surgery, 75 percent of our patients continue to enjoy complete pain relief, and an additional 8 percent have partial relief. Major complications occur in fewer than 5 percent of cases.
In addition to microvascular decompression surgery, UPMC offers treatment options not always available elsewhere, such as Gamma Knife radiosurgery, percutaneous glycerol rhizotomy, and alternative surgical methods.
