Trigeminial Neuralgia
Treatment Options
Treatment options are as follows:
1. Medication
2. Surgery
1. Medications: Various medications used to treat TN
are include:
-
Carbamazepine: This is the most common
anti-convulsant drug that is prescribed to treat TN in the initial
stages in a majority of patients.
Baclofen:
Baclofen is a muscle relaxant and can be
effectively used in combination with either
Carbamazepine or Phenytoin.
Phenytoin:
Phenytoin is an anticonvulsant medication.
Oxycarbazepine:
This drug is structurally related to
Carbamazepine and preferred due to fewer side
effects.
Other medications
include: Gabapentin, Clonazepam, Sodium
Valporate, Lamotrigine and Topiramate (7).
2. Surgeries: Types of surgeries used
to treat TN include:
A. Non-Destructive Procedure: In this procedure, the
Gasserion ganglion or trigeminal nerve root is not damaged or destroyed.
Microvascular Decompression (MVD): In this non-destructive
procedure, a small incision is made behind the ear after general anesthesia
and an operative microscope is inserted to view the cerebellum (part
of the brain) and trace the trigeminal nerve from the brain stem. Micro-instruments
are used to mobilize the blood vessels away from trigeminal nerve. The
decompression is carried out by inserting permanent implants, such as
shredded Teflon, felt between vessels and nerves.
B. Nerve Injury/Destructive Procedures
(Rhizotomies): This procedure is aimed at
damaging the trigeminal nerve root or Gasserion ganglion.
a) Percutaneous Glycerol Rhizotomy: In this procedure,
a spinal needle (of size 3.5”x20 G) is inserted in the skin beside
the mouth and directed through an opening at the base of the skull and
the location of needle is ensured by viewing through an X-ray. A chemical
by the name Glycerol is injected to injure the Gasserion ganglia and
consequently alleviate the pain due to TN.
b) Percutaneous Balloon Compression Rhizotomy: In
this procedure, the needle inserted into the Gasserion ganglion is larger
in size and thus allows the passage of a special catheter fitted with
an inflatable balloon. The balloon is then inflated to compress and
mechanically injure the Gasserion ganglion and the trigeminal nerve
root.
c) Radiofrequency Rhizotomy: This procedure requires
the patient to be awake to describe the degree and extent of facial
numbness generated by radiofrequency lesion. An electrode is inserted
to reach the Gasserion ganglion and heated to cause a thermal injury
to trigeminal nerve while the patient is given strong sedation.
d) Stereotactic Radiosurgery (Gamma Knife): In this
technique, focused radiation on the trigeminal nerve root leads to injury.
About 201 focused beams of cobalt radiation are directed at the trigeminal
nerve root by positioning a Gamma Knife with the help of a MRI.
e) Peripheral Trigeminal Nerve Blocks, Sectioning and Avulsions:
In this procedure, branches of trigeminal nerves exiting the skull just
under the skin or mouth lining are injured by injecting alcohol or cutting
(sectioning) the nerve branch. This procedure is done in the elderly,
frail, or medically infirm people.
f) Microsurgical Rhizotomy: This
procedure involves surgical exposure and cutting of
the trigeminal nerve root to alleviate pain due to TN
(8).
Article by Kona Vishnu, MS
Medical Writer,
OmniMedicalSearch.com
Sources:
- Trigeminal
Neuralgia Fact Sheet, National Institute of Neurological Disorders
and Stroke (NINDS), December 2007.
- Part
One: Characteristics and Causes of Trigeminal Neuralgia, Anatomy
of the Trigeminal Nerve, Centre for Cranial Nerve Disorders, A.M. Kaufmann
and M. Patel, 2001.
- Trigeminal
Neuralgia (Facial Nerve Pain), eMedicineHealth, Edward Lubin,
October 2005.
- Trigeminal
Neuralgia, eMedicine, J. Stephen Huff, August 2007.
- Part
One: Characteristics and Causes of Trigeminal Neuralgia, Types
of Trigeminal Neuralgia and their causes, Centre for Cranial Nerve Disorders,
Winnipeg, University of Manitoba, Health Sciences Centre, A.M. Kaufmann
and M. Patel, 2001.
- Trigeminal
Neuralgia, Mayoclinic.com, April 2006.
- Trigeminal
Neuralgia, What is Neurosurgery, Neurosurgerytoday.org, March
2006.
- Part
Two: Treatment of Trigeminal Neuralgia, III. Surgery,
Nerve Injury/Destructive Procedures (Rhizotomies), Centre for Cranial
Nerve Disorders, Winnipeg, University of Manitoba, Health Sciences Centre,
A.M. Kaufmann and M. Patel, 2001.
Article by Kona Vishnu, MS
Medical Writer,
OmniMedicalSearch.com
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