Trigeminal neuralgia
Trigeminal neuralgia is a pathology characterized by an acute facial pain along one of the territories of the trigeminal nerve. The pain could be localized on the jaw, on the cheek or in the frontal region.
In the majority of cases, the pain is limited to only one side, the attack lasts only few seconds and are frequently provoked by the stimulation of the nerve (trigger point).
Trigeminal neuralgia could be secondary to a neuro-vascular conflict between the trigeminal nerve and a cerebral artery inside of the bone skull. The other etiologies are the idiopathic neuralgia (without anatomic etiology), a brain tumor, a vascular malformation, or an inflammatory process.
Cerebral MRI is the key exam to see an anatomic etiology for a trigeminal neuralgia.
To live with the trigeminal neuralgia could be difficult especially during a long period. For this reason, the treatment choose is important and based on the etiology of the problem.
Different therapeutic options are:
- Pharmacologic therapy
- Surgery of neuro-vascular decompression
- Other surgical approaches
Pharmacologic therapy
Antiepileptic therapy remains the first symptomatic treatment for the idiopathic trigeminal neuralgia. In case of drug-resisting pain and in presence of a clear neuro-vascular conflict on the MRI, the neuro-vascular decompression could/must be considered.
Neuro-vascular decompression
If the pain is resistant to the first line therapy and in presence of a clear neuro-vascular conflict, the surgery is an excellent, efficiency and secure option to control the pain.
The goal of the surgery is to place a spacer between the trigeminal nerve and the artery in the sub-arachnoid space.
The surgery is performed under general anesthesia. The skin incision is behind the ear on the involved side. With the operative microscope, the trigeminal nerve is liberated from from the artery and a Teflon is inserted between the two structures. No vascular or neurologic structure need to be sacrificed.
Most of patients do not have the pain immediately after the surgery and this technique is the most efficient in case of neuro-vascular conflict.
Dr Robert and Dr Bonasia have an important experience in this surgery and especially for trigeminal neuralgia. We perform this type of surgery at Clinique de La Source in Lausanne.
Other surgical approaches
1. Stereotactic radiosurgery
Radiosurgery is an option in the treatment of the trigeminal neuralgia reserved to complex cases after recurrence of the pain in post-surgical period or for patients too ill to be operated on. This is an irreversible destructive treatment of the nerve.
2. Percutaneous glycerol injection
This is a surgical technique that allows from a percutaneous approach to inject a little volume of glycerol in the nerve ganglion to destruct nociceptive fibers.
3. Balloon compression
Durin g this procedure, from the same per-cutaneous approach, a balloon is positioned near the nerve ganglion. The inflation of the balloon allows the compression of the nerve and the destruction of its nociceptive fibers.
4. Trigeminal rhizotomy by radiofrequency
With the same per-cutaneous approach the nerf is destruct by thermic effect.