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Trigeminal
Neuralgia
Trigeminal Neuralgia (TN) is spontaneous lightning-like flashes of pain in the face from spontaneous firing of the trigeminal nerve. Some think TN is caused by a blood vessel pressing on the nerve. An operation of opening the skull and exposing the nerve to remove blood vessels from around it, called Microvascular Decompression (MVD) is often successful. In older patients, the risk is not insignificant and it is older patients who usually get TN Medicine can help. Usually Tegretol, Neurontin, or Lyrica are tried. These are prescribed by a medical neurologist, a brain and nerve specialist who doesn’t do surgery. If medicines don’t help, or if the dose needed is so high that side-effects become a problem, then the neurologist refers to a neurosurgeon. Older simple surgical treatments are cutting branches of the nerve or injecting them with a killing substance such as alcohol. Another procedure is to place a needle through a hold in the skull base, through the mouth (with the patient asleep of course) and damage the nerve by injecting glycerol (a mild alcohol), compressing the nerve with a balloon catheter, or heating up the nerve to damage it with a special needle (thermistor-tip). All of these treatments leave numbness in the area of pain. The latest
method of treatment of TN is Gamma Knife radiosurgery. For more information
on that, click on the section for Gamma Knife. More information is also
on this web site under Cranial Nerve. Gamma Knife is the only surgical
treatment with almost no complications or risk and that does not cause
numbness in the majority (95%) of cases. |