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Cranial Nerve

Twelve pairs of nerves come directly off the brain, the most obvious ones being the nerves of smell, sight and hearing. Other cranial nerves (CN) provide power and sensation to the face, tongue and swallowing muscles, turn the eyes, etc..

The fifth cranial nerve (CN V) is a purely sensory nerve carrying touch and pain sensation from the face. It has three branches, one from the jaw and tongue, one from the upper teeth, nose and cheek, and one from the eye and forehead. Because of these three distinct branches, which come together before entering the brain, CN V is called the trigeminal nerve. An extremely painful condition of this nerve can occur spontaneously causing such pain that the patient twitches with a “tic”. The French named it tic douloureaux - painful spasms. We call it trigeminal neuralgia (TN). See the section on Gamma Knife for the latest treatment for TN

CN VIII, the acoustic nerve is a composite of three nerves, the superior and inferior vestibular nerves (balance) and the cochlear nerve (hearing). CN VII, the facial nerve, gives movement to the face and lies alongside CN VIII. A tumor on CN VIII, called either an acoustic neuroma or a vestibular Schwannoma (Schwann cells wrap around CNs and are what form this tumor and it usually begins on a vestibular nerve) can cause loss of hearing and chirping (tinnitus). The best treatment for these tumors when less than 3 cm. In diameter is radiosurgery with the Gamma Knife. See the section on Gamma Knife.

CN VII, the facial nerve, sometimes fires off and causes spasms of one side of the face. If Botox injections don’t work, a delicate operation can be done to look for a blood vessel compressing the nerve and remove it. This surgery risks loss of hearing because the facial nerve is so near the acoustic nerve.

Other CN problems are rare. An ominous symptom is a dilated pupil and a drooped eyelid, usually also with some double vision. That is usually to diabetic neuropathy, but can be due to an expanding aneurysm (a ballooning artery). A ruptured aneurysm inside the head is a serious thing. About a third die, a third have brain damage, and a third can come out all right.