Trigeminal Neuralgia
Trigeminal Neuralgia (TN), also called tic douloureux, is a type of chronic pain disorder that causes sudden, intense facial pain. It is a disorder of the trigeminal nerve- the 5th cranial nerve, that’s one of the largest nerves in a human head. There are two trigeminal nerves on either side of the face responsible for transmitting facial and head sensations of touch and pain to the brain.
Trigeminal neuralgia is of two forms: Typical (Type 1) and Atypical (Type 2), both varying in their symptoms. People with Type 1 trigeminal neuralgia are likely to experience the following symptoms:
- Brief episodes of extreme pain lasting from less than a second to a few minutes
- Intense, intermittent pain that feels like stabbing, shooting, sharp, or like electric-shock
- Painful bouts that are usually confined to one side of the face- upper and lower jaw, eye, nose, lips, scalp, and forehead
- A tingling sensation or numbness or an aching jaw or cheek area before the beginning of the pain episode
- Pain triggered by stimuli or normal routine activities such as brushing teeth or hair and loud noises.
Type 2 trigeminal neuralgia is typically less common. It is less painful and intense rather than more widespread. People with Type 2 trigeminal neuralgia experience constant pain and discomfort. Vascular compression is the underlying cause of trigeminal neuralgia.
Thankfully, patients suffering from any type of trigeminal neuralgia can be treated with a combination of medications (first line of treatment), surgery, and complementary therapies. Medications include anticonvulsants, muscle relaxants, tricyclic antidepressants, and others. Patients who are unresponsive to medications could be a suitable candidate for Trigeminal Neuralgia Surgery in Hyderabad.
Benefits of Trigeminal Neuralgia Treatment
- Trigeminal Neuralgia surgery can be performed using various surgical options if the patient's condition has worsened over time. The surgical approach can help ease pains or aches for years to come.
- Some of the surgical techniques are less invasive and provide short-term pain relief while there is more invasive, microvascular decompression that is most successful in providing pain relief for up to a decade.
- Less invasive surgeries are associated with quick recovery and minimal post-surgery discomfort.
Neurosurgeons in Hyderabad will recommend the surgical method based on the patient’s severity of pain, preferences, health status, previous surgeries, and benefits/risks of surgical options.
Before Trigeminal Neuralgia Surgery
The neurosurgeon performs a surgical evaluation for trigeminal neuralgia. This involves confirming the diagnosis of trigeminal neuralgia by reviewing the patient’s medical history, and looking at the symptoms while performing a thorough physical examination of the head and neck area including the ear, mouth, teeth, and TMJ.
The Best Trigeminal Neuralgia Treatment Doctors in Hyderabad even conducts a neurological examination and may use MRI to exclude other potential causes of facial pain such as Multiple sclerosis and brain tumours. After reviewing the MRI brain scans, the surgeon may even evaluate the severity of the pain, the general medical condition of the patient, and the patient’s preferences for surgical treatment goals against risk aversion.
Just a few days or weeks before the trigeminal neuralgia surgery, the patient can expect to go for pre-surgical testing which often includes blood tests, chest X-ray, and EKG to check for the patient’s general health status. In the case of microvascular decompression surgery, the patient is not advised to eat or drink anything for at least 6-8 hours prior to the surgery.
However, for gamma knife radiosurgery, preoperative fasting is often not needed. In any case, the patient needs to arrange for someone to drive back home post-surgery and take care at home. The patient must stick to only medications and supplements allowed by the surgeon before the surgery.
What does Trigeminal Neuralgia Surgery Involve?
There are different surgical options to treat Trigeminal Neuralgia in Hyderabad. These are detailed as under:
- Microvascular decompression (MVD)- Also called as Janetta procedure, MVD is the most invasive, common operation to treat trigeminal neuralgia. It is an open surgery wherein a small cut is made behind the patient’s ear, a tiny hole is made in the skull, and the trigeminal nerve is exposed under microscopic visualisation. Trigeminal Neuralgia Specialists in Hyderabad shifts the blood vessels that compress the trigeminal nerve using an endoscope and interposes a Teflon felt padding. It is performed under general anaesthesia.
- Stereotactic Radiosurgery (Gamma Knife)- It is the least invasive option, technically not a surgery. The procedure involves the use of a gamma knife- a radiation-emitting device that aims the radiation beams at the trigeminal nerve to heat damage it and thus stop the transmission of pain signals.
- Radiofrequency lesioning/rhizotomy- This option is best for high-risk patients with severe pain and concurrent illness that makes microvascular decompression dangerous. The procedure involves inserting an electrode through the patient’s cheek to thermally damage the trigeminal nerve and stop the pain signal transmission to the patient’s brain.
- Balloon compression- In this surgery, the surgeon places a cannula through the cheek to the trigeminal nerve and through it inserts a catheter with a balloon at its end. The surgeon then inflates the balloon to damage the pain-causing fibres. It can provide pain relief for 1-2 years.
- Glycerol injection rhizotomy- This approach involves the administration of glycerol into the nerve centre- the root of the trigeminal nerve where it splits into three branches. It causes selective damage to trigeminal nerves which disrupts the transmission of pain signals to the brain. As a result, the pain is suppressed for 1-2 years.
Good Candidates for Trigeminal Neuralgia Surgery
- Anyone experiencing trigeminal neuralgia pain who finds medications not effective despite increasing their doses or when these medications have serious side effects
- Patients showing classical symptoms of trigeminal neuralgia and are otherwise healthy.
After Discharge
- The patient can take pain-relieving medication as per the weaning schedule set by the surgeon until the patient experiences minimum to no pain after a certain time.
- During the initial week of recovery, the patient can gradually increase mobility at home.
- Avoid heavy weight lifting or strenuous activities for a few weeks.
- Go for a follow-up visit to check for recovery status and inspect incisions for signs of infection.
Cost of Trigeminal Neuralgia Surgery in Hyderabad
The price of trigeminal neuralgia surgical treatment depends upon various factors, including:
- The surgical option chosen
- The surgeon’s expertise
- Anaesthesia
- Hospital stay (if needed)
- The location where the operation is performed.
For more details on Trigeminal Neuralgia Treatment in Hyderabad, consult the experts at Arete Hospitals.
Effectiveness of Trigeminal Neuralgia Surgery
In a prospective study, it was found that trigeminal neuralgia surgery can make 92.5% of patients pain-free for an average of 28 months, without medications. Another study revealed, 85% of patients have reported adequate pain control by an average of 38 months.
Risks Associated with Trigeminal Neuralgia Surgery
Typical surgical risks for microvascular decompression and percutaneous rhizotomy include:
- Infection at the incision site
- Excessive bleeding
- Numb spots on the face
- Weakening of facial muscles
- Impaired speech
- Anaesthesia-related risks
- Leakage of spinal fluids.
The common risk associated with gamma knife radiosurgery is fatigue. For pain stimulator placement, the risks are minimal. Some patients may experience pain and swelling around the placement.
1. Who is more likely to get trigeminal neuralgia?
Trigeminal neuralgia mostly affects mid-aged or older people. But it can even affect other ages, including infants. This disorder is more commonly seen in women than men.
2. Can I prevent trigeminal neuralgia?
Unfortunately, you can’t. However, you can still prevent painful episodes associated with the condition by avoiding any activities that can worsen the pain.
3. Does trigeminal neuralgia worsen over time?
Yes, it certainly can. In the initial stage of trigeminal neuralgia, the pain is restricted to the jaws of the patient. However, if the jaw ache is ignored, the pain may increase in intensity and interfere with the patient’s routine activities. Over time, pain management can even become less effective.
4. How long will my hospital stay for trigeminal neuralgia surgery?
Typically, you will get discharged from the hospital after 2 days of your surgery, if you have undergone microvascular decompression surgery. For radiofrequency procedures, the treatment is outpatient.
5. How long is the recovery after trigeminal neuralgia surgery?
The recovery time frame varies among the patients based on the surgical option chosen. After a microvascular decompression, the patient would have to wait for 4-6 weeks to return to normal routine activities.
Arete Hospitals, stands out as a leading Trigeminal Neuralgia Treatment Hospital in Hyderabad. Our commitment to exceptional patient care and a superior hospital experience is unmatched in the country. We boast a team of renowned specialists and access to advanced technology, all conveniently housed within our facility, guaranteeing top-tier treatment for our patients.
