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Trigeminal Neuralgia

Trigeminal neuralgia, also called tic douloureux, is severe facial pain—perhaps one of the most excruciating pains encountered in medicine. Trigeminal Neuralgia, a chronic condition, causes sudden, extreme burning or shock-like face pain that lasts anywhere from a few seconds to two minutes. The intensity of the pain can be mind-numbing and physically incapacitating.

Barnes-Jewish & Washington University Neuroscience Center is among few centers in the region to offer the level of care and Trigeminal Neuralgia treatment options we provide for this debilitating condition. We are also the only hospital in the region that offers the Gamma Knife radiosurgery technology for treating this condition.

Understanding Trigeminal Neuralgia

Trigeminal neuralgia pain is typically felt on one side of the jaw or cheek, and most often occurs in people over age 50, and is more common in women than in men. Pain can be triggered by eating, talking, brushing the teeth, rubbing the part of the face where the pain arises or by a cold wind. The pain may occur in areas of the face, including the eyes, lips, nose, scalp, forehead, teeth or jaw, but typically does not spread to other areas once it starts.

Trigeminal neuralgia may be caused by a nearby blood vessel compressing and damaging the trigeminal nerve. More rarely, it is caused by a tumor involving the nerve.

The diagnosis is made from the patient’s description of the pain. The electrical, stabbing quality of the pain, its unpredictable onset and its consistent location usually makes the diagnosis clear.

Trigeminal Neuralgia Treatment

Trigeminal neuralgia does not respond to ordinary pain medications and narcotics. However, it is frequently relieved by anticonvulsant medications. Carbamazepine (Epitol, Tegretol) is usually effective within one to two days, but can cause side effects such as nausea, drowsiness, a sense of unsteadiness or feeling "out of sorts." Other trigeminal neuralgia treatment options include drugs that might be effective in controlling the pain in some patients include gabapentin (Neurontin), oxcarbazepine (Trileptal), preglabin (Lyrica), phenytoin (Dilantin), lioresal (Baclofen), valproic acid and lamotrogine.

Trigeminal Neuralgia Surgery Options

If medicine cannot adequately control the pain of trigeminal neuralgia, there are a number of surgical procedures that can be done. The most common trigeminal neuralgia surgery options that we perform are microvascular decompression of the trigeminal nerve, Gamma Knife radiosurgery and percutaneous radiofrequency procedures of the trigeminal nerve.

Microvascular decompression is a major intracranial operation that can relieve the face pain without facial numbness. An incision is made behind the ear and a small hole is drilled in the skull to expose the nerve at the base of the brainstem. Using a microscope and endoscope, the neurosurgeon visualizes the vessels that are pressing against the nerve, peels them away and separates the vessels from the nerve with a Teflon pad. Pain relief is immediate, and the procedure has the lowest recurrence rate of any surgical treatment. However, the procedure is major surgery and requires a 3-4 week recovery period before patients can go back to work.

Gamma Knife radiosurgery is a less invasive trigeminal neuralgia surgery option that uses radiation to injure–and thus deaden–the nerve causing the pain. Because no incisions are made during Gamma Knife radiosurgery and the method of radiation delivery is precise, the risk of surgical complications is low and patients have little discomfort. There is a delay in onset of pain relief, but Gamma Knife is a good option for patients who do not need immediate control of pain, don’t have other diseases, older patients or those who do not want to undergo an open operation.

Gamma Knife can be performed even if a patient cannot undergo an MRI. For these patients, CT technology is used to visualize the nerve problem.

Percutaneous radiofrequency rhizotomy is not a major intracranial operation, but involves the use of a needle to introduce a heating current, which destroys and deadens part of the nerve. The procedure requires the creation of some permanent numbness to relieve the trigeminal neuralgia. Percutaneous radiofrequency rhizotomy and percutaneous glycerol rhizotomy–in which the chemical glycerol is injected–are less frequently used as a trigeminal neuralgia treatment.

Neuroscience Center neurosurgeons are the only specialists in the St. Louis region to offer the full spectrum of microvascular decompression, Gamma Knife and percutaneous procedures as options for trigeminal neuralgia treatment.

For a referral to a Washington University neurologist or neurosurgeon at Barnes-Jewish Hospital, call 855.925.0631.

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