The commonly accepted cause of trigeminal neuralgia (“Tic Doloreaux”) is an injury to the “root entry zone” of the trigeminal nerve. A touch to the face, lips or even a breeze can cause normal nerve impulses to go to this damaged area where something akin to a “short circuit” occurs, leading to excruciating pain for which trigeminal neuralgia is known. Dr. W. James Gardner, the earliest Chairman of Neurosurgery of Cleveland Clinic, was the first to propose this etiology for trigeminal neuralgia, recognizing the important role of blood vessel compression of this trigeminal nerve area, and its treatment, microvascular decompression.
Trigeminal neuralgia treatment has evolved over the years into three classes:
Rhizotomy procedures prevent these nerve impulses from ever reaching the injured root entry zone by selectively injuring certain portions of the trigeminal nerve. Techniques used to perform trigeminal neurolysis involve direction of a needle through the cheek into the region of the “Gasserian ganglion” where selective nerve injury is produced by techniques such as heating with radio-frequency probes, chemical treatment with glycerol, or mechanical compression of the trigeminal nerve with a balloon. This trigeminal neuralgia treatment usually results in immediate pain relief, but its principal complications are permanent objectionable facial numbness, blood vessel injury and, for certain procedures, early recurrence. Catastrophic complications are rare.
Micro-surgery for trigeminal neuralgia, aimed at removing the source of the compression requires a craniotomy at the base of the skull. Neuralgia symptom relief is usually obtained through microvascular decompression where the offending blood vessel is physically moved away from the trigeminal root entry zone. On occasion, a more radical approach is required such as partial or complete cutting of the nerve. Principal complications of this approach are permanent objectionable facial numbness, deafness, coordination problems, stroke, and wound healing problems. Often, a vessel is not found as imaging may be unreliable. Catastrophic complications from this trigeminal neuralgia treatment are infrequent.
Gamma Knife treatment allows non-invasive treatment management of trigeminal neuralgia symptoms. Although the success rate (very good to excellent pain relief) is not as high as for rhizotomy, the Gamma Knife procedure has a much lower incidence of complications, including facial numbness. Pain relief is usually delayed by a few weeks to a few months after treatment. It should be considered in any patient with trigeminal neuralgia who has failed medical therapy where the risk of facial numbness is undesirable, and who can tolerate the latency period before pain relief. Catastrophic complications from this trigeminal neuralgia treatment are rare.
To schedule an evaluation with a Burkhardt Brain Tumor Center specialist, please call our Appointment Center at 216.636.5860 or toll-free at 866.588.2264.