The Treatment of Trigeminal Neuralgia

Disruption of the function of a specific nerve can sometimes result in the development of neuralgic pain, which is pain that is caused when unneeded pain signals are transmitted from a nerve to the brain, that is, when no damage or injury has occurred in the region for which that nerve is responsible. The trigeminal nerve can be the source of a form of neuralgic pain that is considered to be relatively common, particularly as pertains to the region of the head and face. This condition, commonly known as trigeminal neuralgia, can cause intense pain in a specific area of the face, sometimes lasting for extended periods of time – necessitating appropriate treatment.

At the Neurosurgical Center for Excellence at the Herzliya Medical Center, there are surgical specialists in the fields of neurosurgery and microsurgery with extensive experience in the treatment of trigeminal neuralgia.

About Trigeminal Neuralgia and Associated Symptoms

Trigeminal neuralgia is named for the affected nerve that is the source of the facial pain it causes. The trigeminal nerve is the largest of the cranial nerves and is divided into three main branches, hence its name. The three branches are responsible for the innervation of different regions of the face:

• The ophthalmic nerve innervates the area around the eyes, eyebrows, forehead and more.
• The maxillary nerve innervates the tissues around the upper jaw, lower eyelid, upper lip, nostrils, soft and hard palates and more.
• The mandibular nerve innervates the lower lip, cheeks, tongue and more.

When the trigeminal nerve is damaged, usually just one of its three branches is affected, directly affecting the region of the face innervated by the specific branch. Damage to the nerve typically results in sharp pain that usually appears on one side of the face, typically in the region of the upper or lower teeth. Rarely, the pain can appear in the top part of the face, and even more rarely, the pain can appear in multiple regions of the face at once. The pain caused by trigeminal neuralgia can be momentary (lasting one minute or less) or relatively prolonged. The episodes can occur at infrequent intervals, such as once every few weeks or months, or with much greater frequency.

Why does this pain occur?

The nerve fibers in our bodies are highly sensitive, particularly to direct pressure. When pressure is applied to a nerve for an extended period of time, it can result in significant disruption of nerve function, even resulting in complete destruction of the nerve’s ability to transmit signals to and from the brain.

Trigeminal neuralgia is caused exactly by this mechanism: prolonged pressure on one of the branches of the trigeminal nerve, typically from an artery that runs adjacent to the damaged branch. That said, it remains unclear to this day what causes the artery to impinge upon the nerve (as in normal circumstances, the same artery also runs adjacent to branches of the trigeminal nerve without exerting pressure on the nerve).

Precise Diagnosis of Trigeminal Neuralgia

The diagnosis of trigeminal neuralgia is considered to be especially complex and challenging, particularly because the pain it causes, which appears most commonly, as mentioned previously, in the lower or upper jaw regions, can often be dismissed as standard toothaches. In many cases, patients are diagnosed with trigeminal neuralgia after having undergone extensive dental treatments that have proved ineffective in relieving the pain, as the source of the pain was not in the teeth but rather was the result of damage to the nerve branch responsible for that region.

Precise diagnosis of trigeminal neuralgia relies, first and foremost, on how you report your pain to your physician, including the frequency of pain episodes and when the pain appears (it is well known, for example, that pain that results from trigeminal neuralgia typically appears during waking hours and is less prominent during sleep). Physicians experienced in treating the condition, such as the neurosurgical specialists at the Herzliya Medical Center, are able to differentiate between standard toothaches and the pain caused by trigeminal neuralgia.

If you are diagnosed with trigeminal neuralgia, you will be sent for imaging tests such as MRI and CT , during which your doctor will be able to identify the exact location of the pressure on the nerve in question. This precise diagnosis ensures, among other things, that the most appropriate medical decisions are made regarding the safest and most comfortable treatment method.

The Treatment of Trigeminal Neuralgia

There are a number of ways to treat trigeminal neuralgia, including treatment with medications (which is usually effective only during the earliest stages of the condition), treatment using ultrasonic waves, and ablation therapy. However, the treatment that in most cases offers the best results is an operation for the treatment of trigeminal neuralgia, called micro-vascular decompression (MVD) of the trigeminal nerve.

MVD is a microsurgical technique that is performed using special and highly precise instruments that allow the surgeon to physically separate the damaged nerve branch from the adjacent blood vessels that are pressing on it. First, the two structures are carefully separated, ensuring that the various tissues involved are not damaged, and then, felt-like insulation is placed between the structures to prevent any future contact between the blood vessel and the nerve branch.

This separation immediately alleviates the pressure on the damaged nerve, thereby allowing it to heal. It can take a relatively long time for the nerve fibers to recover, and their rehabilitation proceeds at a fairly slow pace. Nevertheless, the relief of pressure on the nerve and its separation from the blood vessels will effect an immediate improvement in the condition and significant pain relief, often alleviating the pain altogether.

Surgery for decompression of the trigeminal nerve usually lasts two hours and requires excellent skill of the surgeon. Doctors who are world renowned experts in the treatment of trigeminal neuralgia operate at The Neurosurgical Center for Excellence at the Herzliya Medical Center. Thanks to them, you will be able to fully recover, leaving the tormenting facial pain behind.

Have you been suffering from prolonged pain of a specific area of your face?

Have you undergone extensive dental treatments that haven’t helped?

Contact us today at the Neurosurgical Center for Excellence at the Herzliya Medical Center to ensure that the problem is treated by the best of our doctors.