Trigeminal neuralgia, which creates intense pain in the jaw, is usually treated first by medications and secondarily by surgical procedures, including stereotactic radiosurgery, percutaneous rhizotomy, and microvascular decompression.
Once diagnosed with trigeminal neuralgia, the first line of treatment is almost always medical therapy. Medications—including anticonvulsants, muscle relaxants, and tricyclic antidepressants—will relieve the pain in roughly 75 percent of trigeminal neuralgia patients.
Trigeminal neuralgia surgery is an effective treatment for the 25 percent of patients who do not respond to medications or have negative side effects from medications. Knowing about surgical options is also valuable for patients whose pain is currently controlled by medications because trigeminal neuralgia pain can escalate quickly.
Unlike many neurosurgery practices that offer only one type of TN surgery, the Colorado Trigeminal Neuralgia Clinic at Neurosurgery One offers multiple surgical options to treat TN. Our experts treat patients from throughout Colorado, Wyoming, western Kansas, and New Mexico. We also consult on cases throughout the country.
FAQs About Trigeminal Neuralgia Treatments
Continue reading below to learn more about trigeminal neuralgia treatments or click on one of these links to go directly to the information you are interested in.
- How is stereotactic radiosurgery used to treat trigeminal neuralgia?
- What is percutaneous rhizotomy and how is it used to treat trigeminal neuralgia?
- What is microvascular decompression and what are the benefits of using it to treat trigeminal neuralgia?
- Can multiple types of surgery be performed to treat trigeminal neuralgia, especially if it returns?
Conditions We Treat
How is stereotactic radiosurgery used to treat trigeminal neuralgia?
Stereotactic radiosurgery is sometimes called gamma knife treatment although it now can be performed on other types of radiation systems. This procedure uses focused beams of intense radiation to damage the trigeminal nerve. By damaging the nerve, this non-invasive outpatient treatment stops the nerve from conducting pain signals. Since the beams are focused directly on the trigeminal nerve, the procedure results in minimal damage to healthy tissue. The procedure is completed in one visit with essentially no recovery time.
- Outcomes: Up to 96% chance of improvement (Can be repeated, with secondary procedures providing an 89% success rate, even in those whose condition recurred or who failed initial treatment.)
- Benefits: Outpatient, noninvasive procedure; no anesthesia; virtually no risk or recovery time, other than a 2% chance of permanent numbness (not weakness or sagging)
- Drawbacks: Delayed pain relief, up to a month or more, but typically within one week; slightly lower success rate than other surgical therapies
- Ideal Candidate: Most patients with trigeminal neuralgia; in particular, those with relatively good but not great control who are willing to undergo a very low-impact procedure without any recovery time to lessen their pain, their side effects or their need for medication
Stereotactic radiosurgery can be performed in one day, with patients able to return to work immediately.
What is percutaneous rhizotomy and how is it used to treat trigeminal neuralgia?
Percutaneous stereotactic radiofrequency rhizotomy (PSR) also is used to damage the trigeminal nerve to prevent it from transmitting pain signals. Guided by X-ray, the surgeon inserts a thin needle through the patient’s cheek into the trigeminal nerve to damage it and stop it from transmitting pain signals to the “short circuit” and on to the brain. The surgeon can damage the nerve by injecting glycerol, burning it with radiofrequency energy, or crushing it with a balloon.
With PSR, control rates are slightly higher and recurrence rates are slightly lower than with the other needle-based procedures. Although the incidence of numbness is greatest with this procedure, surgeons use this needle method most often to treat trigeminal neuralgia because, on average, it has the most positive effects with the fewest drawbacks. Percutaneous rhizotomy has a 90-95% rate of curing trigeminal neuralgia, with a low (20-25%) rate of the condition returning, according to a study published in the Journal of Neurosurgery.
Other points about this procedure:
- Outcomes: 90-95% cure rate, 20-25% recurrence rate
- Benefits: Outpatient procedure; local anesthesia; immediate relief
- Drawbacks: Guaranteed facial numbness, with a 1% chance of severe facial numbness or burning pain called “anesthesia dolorosa”
- Ideal Candidate: Patients who have failed other methods; older patients with anesthesia risks who have such severe pain that they are not eating or drinking adequately
What is microvascular decompression and what are the benefits of using it to treat trigeminal neuralgia?
Available since the 1950s, microvascular decompression (MVD) is also sometimes referred to as posterior fossa exploration. Considered the “gold standard” in trigeminal neuralgia treatment in the past, MVD is still thought by some to be the only good surgical option for trigeminal neuralgia patients. It involves making a small incision behind the ear and implanting a small felt pad between the blood vessels and the trigeminal nerve to alleviate the pressure and resulting “short circuit.”
- Outcomes: Microvascular decompression offers up to a 90–95% cure with 20–25% recurrence.
- Benefits: Immediate relief; less than a 1% chance of serious complications (in the hands of a surgeon with significant experience); minimal risk of numbness
- Drawbacks: Inpatient surgery requiring general anesthesia, small surgical risks and a two-day stay in the hospital, with around two weeks of recovery at home
- Ideal Candidate: Many patients of all ages with limited anesthesia risk; MVD for TN is a safe procedure even in the elderly; the risk of serious morbidity or mortality is similar to that in younger patients
Can multiple types of surgery be performed to treat trigeminal neuralgia, especially if it returns?
In cases of trigeminal neuralgia that don’t respond to treatment, multiple surgical treatments—which can be attempted in any order—can be used and even may be necessary to get long-lasting pain relief.
Although scarring from stereotactic radiosurgery was once believed to prevent the use of other surgical techniques, it has since been found this is not the case. MVD is occasionally repeated, especially after long periods of relief. Occasionally, partial cutting of the nerve (partial sensory rhizotomy, or PSR) is necessary when multiple other attempts have failed.