Trigeminal Neuralgia Treatments
For more information, please visit our Comprehensive Facial Pain/Trigeminal Neuralgia Program site
Percutaneous Rhizotomy
What is it?
The surgical disruption of the trigeminal nerve root as a means of limiting pain.
What is its goal?
The purpose of this procedure is to compress the trigeminal nerve to disrupt the pathway that causes the pain.
How is it done?
The procedure is done under general anesthesia. Under x-ray control, a needle is introduced through your cheek into the trigeminal nerve, using an opening in your skull called the foramen ovale.
A balloon is expanded and compresses the nerve. You are asleep when this happens.
How long will I stay in the hospital?
After surgery, you will be taken to the post anesthesia care unit and then to the same day surgery unit. Some people need to stay over night, but most go home that evening.
Going home
You will have a band-aid on your cheek. Most people have rapid relief of their pain. You should also expect facial numbness, which slowly improves but may be permanent.
About 90-95% of patients will find that their facial pain disappears immediately after the balloon procedure, although for some patients it may take a day or so for the pain to go away completely. The pain-free period varies from person to person, but half the people will still be pain free after 5-8 years. This procedure can be repeated if necessary.
Most patients will experience some degree of facial numbness post operatively. This will decrease over time. The numbness indicates the nerve has been successfully damaged to prevent trigeminal neuralgia pain from reaching the brain, which is the aim of the surgery. Some patients may also experience weakness in the chewing muscles after the surgery, although this is usually temporary and will resolve over the first few weeks.
What are the risks?
There are always risks with any surgery. A small percentage of patients (up to 5%) may experience complications. These include meningitis, difficulty chewing, a cheek hematoma, double vision, loss of the corneal reflex, anesthesia dolorosa, a sudden rise or drop in blood pressure, cerebrospinal fluid leaks and meningitis, and an outbreak of cold sores.
Microvascular Decompression
What is it?
Microvascular Decompression is a surgical procedure to relieve the symptoms (pain, muscle twitching) caused by compression of a nerve by an artery or vein. It provides the longest duration of relief from trigeminal neuralgia pain, and the lowest rate of permanent numbness of the face after surgery.
What is its goal?
The purpose of Microvascular Decompression is to relieve pressure from a pulsating vessel that is pressing against the trigeminal nerve, causing painful impulses from the face.
How is it done?
The procedure is done under general anesthesia. Hair behind the ear is shaved and a small part of your skull is removed. The nerve is identified and pieces of Teflon are placed between the nerve and the offending blood vessel(s). The small area of bone removal is then covered with a thin metal mesh.
How long will I stay in the hospital?
Most patients are discharged after 2 nights.
Going home
Approximately 95% of patients will have rapid relief from pain. You will need to continue all preoperative pain medication. These will be slowly decreased after one month by the physician who started them. Staples/sutures are removed 10 to 14 days after surgery. Most patients may also experience muffled hearing on the side of surgery, facial numbness, fatigue from anesthesia, nausea/vomiting in the hospital (meds will be given) which usually improves over time. You may not drive or go back to work for about one month. You cannot wear wigs, use hair dye or other harsh products for 6 months. These will interfere in long term healing and may cause infection which could require further surgery.
What are the risks?
Microvascular decompression is an invasive procedure, and while safe in expert hands, does have potential rare/infrequent risks, including:
• Infection
• Hearing loss, facial numbness, and/or facial weakness (usually temporary, rarely permanent)
• Spinal fluid leak
• Difficulty with speech or swallowing
• Stroke or hemorrhage (very rare)
What is needed before Microvascular Decompression surgery?
• Special MRI (“Trigeminal neuralgia protocol MRI”)
• Special CT scan (“Brainlab CT”)
• Hearing test (audiogram)
• Blood work and possibly a EKG.
• Baseline brain wave monitoring (used to monitor nerves at surgery)
• Preoperative physical and evaluation
• updated list of medicationsto preoperative evaluation
Rochester Neurosurgery Partners
Highland Hospital
Rochester General Hospital
Strong Memorial Hospital
Unity Hospital
