Conditions & Diseases: Brain & Nervous System

Trigeminial Neuralgia

See Also:
Trigeminial Neuralgia: Introduction & Overview
Trigeminial Neuralgia: Forms of TN
Trigeminial Neuralgia: Causes & Risk Factors
Trigeminial Neuralgia: Signs, Symptoms & Diagnosis
Trigeminial Neuralgia: Treatment Options

Treatment Options

Treatment options are as follows:
1. Medications
2. Surgeries

1. Medications: Various medications used to treat TN are as follows:

1. Carbamazepine: This is a most common anti-convulsant drug that is prescribed to treat TN in the initial stages in majority of the patients.

2. Baclofen: Baclofen is a muscle relaxant and can be effectively used in combination with either Carbamazepine or Phenytoin.

3. Phenytoin: Phenytoin is an anticonvulsant medication.

4. Oxycarbazepine: This drug is structurally related to Carbamazepine and preferred due to fewer side effects.

5. 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 nerve.

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 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 to 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 meanwhile the patient is given strong sedation.

d) Stereotactic Radiosurgery (Gamma Knife): In this technique, focused radiation on 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 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).

See Also:
Trigeminial Neuralgia: Introduction & Overview
Trigeminial Neuralgia: Forms of TN
Trigeminial Neuralgia: Causes & Risk Factors
Trigeminial Neuralgia: Signs, Symptoms & Diagnosis
Trigeminial Neuralgia: Treatment Options

Article by Kona Vishnu, MS
Medical Writer,
OmniMedicalSearch.com

Sources:

1. Trigeminal Neuralgia Fact Sheet, National Institute of Neurological Disorders and Stroke (NINDS), December 2007.
2. 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.
3. Trigeminal Neuralgia (Facial Nerve Pain), eMedicineHealth, Edward Lubin, October 2005.
4. Trigeminal Neuralgia, eMedicine, J. Stephen Huff, August 2007.
5. 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.
6. Trigeminal Neuralgia, Mayoclinic.com, April 2006.
7. Trigeminal Neuralgia, What is Neurosurgery, Neurosurgerytoday.org, March 2006.
8. 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.