Trigeminal Neuralgia

Trigeminal neuralgia is a condition characterised by unilateral face pain, often with a unique lancinating “electric” quality, and tending to occur in bouts, sometimes separated by significant pain free periods but tending to become more frequent and persistent over time.

Initial treatment is often by medication. Trigeminal neuralgia typically responds, at least initially, to Tegretol or Lyrica (both anticonvulsant medication with pain blocking abilities against some nerve based pains).

If this is not effective or becomes ineffective, interventional techniques may be considered.

Usually this will follow specific investigations to exclude other causes of pain, or the presence of pathologies that may present similarly (e.g. rare tumours occurring in the base of the skull, or inflammatory patches occurring in multiple sclerosis (an inflammatory central nervous system condition that may cause trigeminal neuralgia).

In the absence of other identifiable causes, trigeminal neuralgia is usually associated with compression of the affected trigeminal nerve, by a loop of blood vessel (usually an artery).

If this is present, pain can usually be abolished by a microsurgical procedure, which dissects the blood vessel away from the nerve and places packing between it and the nerve. In more than 85% of cases this will produce a long term ‘cure’ of the condition.

An alternative treatment, often considered for those who might be medically unfit for definitive surgery but also available as an optional strategy, is a percutaneous injection technique, in which a sterile preparation of glycerol is injected stereotactically around the trigeminal ganglion. In about 90% of cases, pain relief will occur, and typically persist for 18-24 months (occasionally longer).

Uncommonly, after successful microsurgical treatment, there may be a delayed recurrence of pain. Often this is due to recompression of the nerve, typically by a different vascular loop. Should this occur, in many cases pain relief can again be achieved by re-exploring and decompressing the nerve.