Contents
What is Trigeminal Neuralgia?
Trigeminal neuralgia (TN) is a chronic pain disorder that originates from the trigeminal nerve (cranial nerve V) and usually manifests itself as a sudden, intense electric shock sensation on one side of the face. This pain usually occurs in the cheek, jaw, forehead or around the eyes and can seriously interfere with daily activities (speaking, chewing, brushing teeth, washing face, etc.). The pain usually occurs in short-term but recurring attacks. Trigeminal neuralgia is a severe health problem that seriously reduces the quality of life.
Causes of Trigeminal Neuralgia
- It often occurs when a blood vessel (usually an artery) near the trigeminal nerve presses on the nerve. This is called *neurovascular compression*.
- In rare cases, neurological diseases such as multiple sclerosis (MS) or a brain tumor can also cause trigeminal neuralgia.
- Primary (idiopathic) trigeminal neuralgia can occur without any underlying cause.
Trigeminal Neuralgia Treatment
Treatment options can be listed as follows:
1. Drug Therapy:
The first step is usually drug therapy.
Anticonvulsants (e.g., carbamazepine, oxcarbazepine) are commonly used drugs. These drugs try to control symptoms by suppressing nerve hypersensitivity.
Other drugs may include agents such as gabapentin, pregabalin or baclofen.
However, in some patients, drugs may be ineffective or their long-term use may be limited due to side effects.
2. Surgical Treatment:
Surgery is considered in patients who have failed drugs or who have unbearable pain.
One of the most effective surgical methods is *Microvascular Decompression (MVD)* surgery.
Microvascular Decompression Surgery (MVD)
Purpose:
The purpose of MVD is to remove the pressure by separating the blood vessel (usually an artery) that is compressing the trigeminal nerve from the nerve. The aim of this procedure is to eliminate the irritation on the nerve (and the pain caused by it).
Who is it Applied to:
- It is recommended for trigeminal neuralgia patients who do not respond to drug treatment or who cannot be treated due to the side effects of drugs.
- It is generally applied to patients who have appropriate risk criteria for brain surgery.
Surgery Process:
1. Anesthesia: The patient is put under general anesthesia.
2. Surgical Incision: The surgeon makes a small incision near the mastoid bone (the back of the skull base).
3. Craniectomy: A small bone window is opened and the surgeon accesses the area where the trigeminal nerve is located.
4. Separation from Nerve and Vein: The blood vessel that puts pressure on the trigeminal nerve is found. The surgeon carefully separates this vessel from the nerve. A soft tampon (usually made of Teflon material) is placed between the vessel and the nerve to protect the nerve.
5. Closure: After the procedure is completed, the surgeon appropriately closes the brain tissue and the opened area.
Duration of Surgery: It usually takes 2-3 hours.
Advantages of MVD Surgery:
- It has been shown to provide 70-90% pain relief results.
- It does not cause facial numbness or loss of sensation because the trigeminal nerve is not damaged.
- It is possible to experience dramatic reductions in symptoms from the first application.
Risks and Disadvantages of MVD
As with any surgical procedure, MVD carries some risks. These include:
- Cerebrospinal fluid (CSF) leak
- Infection
- Bleeding
- Hearing loss (rare)
- Facial numbness (very rare)
- Risk of postoperative pain recurrence (20-30%)
However, when performed by experienced surgeons, the complication rate of MVD is generally low.
