What is Trigeminal Neuralgia?

Trigeminal neuralgia is a condition that causes severe, sharp facial pain along the distribution of the trigeminal nerve, which provides sensation to the face.

The pain is often described as:

• Electric shock–like
• Sudden and intense
• Triggered by everyday activities such as talking, chewing, or brushing teeth

 

What Causes Trigeminal Neuralgia?

In many cases, trigeminal neuralgia is caused by compression of the trigeminal nerve by a nearby blood vessel.

This constant pulsation against the nerve can lead to:

• Irritation of the nerve
• Disruption of normal signal transmission
• Episodes of severe pain

In other cases, the condition may be idiopathic, meaning no clear structural cause is identified.

 

How is it Diagnosed?

Diagnosis is based on:

• Clinical symptoms and history
• MRI imaging to evaluate for underlying causes

We often obtain specialized MRI sequences such as FIESTA imaging, which can provide high-resolution visualization of the relationship between the nerve and surrounding blood vessels. This can help identify vascular compression in appropriate cases.

 

First-Line Treatment: Medication

The initial treatment for trigeminal neuralgia is almost always medical management.

Common medications include:

• Nerve-stabilizing agents (such as anticonvulsants)

Many patients achieve good pain control with medication alone.

However, over time:

• Medications may become less effective
• Side effects may limit long-term use

 

When is Surgery Considered?

If medications are no longer effective or cause significant side effects, and especially if imaging suggests vascular compression, surgical treatment may be recommended.

 

Surgical Treatment: Microvascular Decompression (MVD)

Microvascular decompression (MVD) is a procedure that relieves pressure on the trigeminal nerve by repositioning the offending blood vessel.

This is the most definitive treatment when vascular compression is present, as it addresses the underlying cause rather than just the symptoms.

 

Minimally Invasive Approach

We perform MVD using a minimally invasive approach, designed to reduce surgical impact while maintaining effectiveness.

Key features include:

• A small incision behind the ear
• A bony opening sometimes as small as a thumbnail
• Precise microsurgical techniques

This approach allows for:

• Less tissue disruption
• Faster recovery
• Excellent outcomes with reduced postoperative discomfort

 

Radiation-Based Treatment

For some patients, a non-invasive option such as stereotactic radiosurgery may be considered.

This involves:

• Focused radiation directed at the trigeminal nerve
• No incision or open surgery

While less invasive, it may:

• Take time to achieve pain relief
• Be less durable compared to microvascular decompression in selected patients

 

Our Approach

We take a stepwise and individualized approach to trigeminal neuralgia.

• We begin with medical management whenever appropriate
• Carefully evaluate for vascular compression using advanced imaging
• Discuss all treatment options, including medication, surgery, and radiosurgery

When surgery is indicated, we emphasize a minimally invasive microsurgical approach to provide durable pain relief while minimizing recovery time.

Our goal is to deliver effective, long-lasting relief tailored to each patient’s condition and preferences.

View the approach