Trigeminal neuralgia, also known as tic douloureux is a condition where there is excruciating pain involved with the trigeminal nerve of the nervous system, and its surrounding area. This pain occurs whenever a person gets an attack of trigeminal neuralgia, depending on the trigger factors involved. The cause of pain is usually due to an artery or any other vessel compressing the nerve, causing the nerve to misfire, leading to pain. Other causes of pain are pressure on the nerve due to a tumor, or due to multiple sclerosis. Though there is no final and definitive cure for trigeminal neuralgia, when the pain becomes unbearable and does not respond to normal medication, then there is a need of a surgery.
Trigeminal Neuralgia Surgery Options
When all other means of controlling the pain caused by trigeminal neuralgia prove to be ineffective, then surgery is the only option left. The trigeminal neuralgia surgery can be of two types - percutaneous, that is through the skin, and open surgery. Percutaneous procedure is preferred in old and frail patients, whereas open surgery is advisable for young and healthy patients. However, the effects of most percutaneous procedures is mostly short-lived, and there are often cases that come back complaining of recurrence of pain.
Microvascular Decompression
Microvascular decompression, though the most invasive of all trigeminal neuralgia surgeries, as it is an open surgery that needs opening through the skull via a craniotomy, though it is also the most effective surgery for pain relief. The first step of this surgery involves the microsurgical exposure of the root of the trigeminal nerve. Then the blood vessel that may be causing pressure on the nerve is identified, after which the blood vessel is lightly displaced from the point of compression, similar to the method employed to bring about relief in spinal decompression. On most occasions, this decompression aids in reducing the sensitivity of the nerve, thus, helping the nerve to return to normalcy. However, there are many surgery risks involved with this invasive surgical procedure, like decreased hearing, facial weakness, facial numbness etc.
Percutaneous Stereotactic Rhizotomy
This procedure helps treat trigeminal neuralgia with the help of heat in the form of electrocoagulation. An electrode is passed through the cheek into the trigeminal nerve, after which a current is passed, which destroys the nervous tissue that is responsible for transmitting the pain signals. This helps relieve the pain considerably, though the risk of facial numbness as a result of this surgery is relatively high.
Percutaneous Glycerol Rhizotomy
This procedure is done under local anesthesia; glycerol is injected into the nerve, at the point where its main trunk divides into three branches. The aim of this surgery is to selectively damage the portion of the nerve that is responsible for passing on the pain signals to the brain.
Percutaneous Balloon Compression
As the name of this surgery for trigeminal neuralgia suggests, a needle is passed through the cheek, after which a balloon is passed through a catheter. Then, the balloon is inflated, so as to compress and irreversibly damage the nerve fibers that cause pain. After a few minutes, the balloon is deflated, and removed, along with the catheter.
Stereotactic Radiosurgery
This trigeminal neuralgia surgery, also known as Gamma-knife radiosurgery, is said to be the least invasive of all the surgical procedures, wherein a single highly concentrated dose of ionizing radiation is given, targeted at the precise location of the nerve that is responsible for sending out pain signals to the brain. This surgery helps avoid many of the possible risks and complications that microvascular decompression and other open surgery procedures pose. Due to the ionizing radiation, after a certain time period, a lesion is formed which prevents the nerve from sending out any further pain signals.
Although trigeminal neuralgia surgery has proven to be quite effective in mitigating the pain, if not getting rid of it completely, the downside is that the success rate and the recovery period differs from patient to patient. Furthermore, there are numerous surgery side effects, varying from recurrence of pain, to facial numbness, to impaired mental health, hence, trigeminal neuralgia surgery should only be performed as a last resort, after all other options for treating the condition have been exhausted.
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