What is Trigeminal Neuralgia?
Trigeminal neuralgia, also known as tic douloureux, is a type of nerve disorder. This chronic condition causes severe, shooting pain in the face. Some people with the condition only experience a fleeting, momentary twinge, while others suffer from frequent bouts of extreme pain.
Trigeminal neuralgia can affect one of several areas of the head and face. The trigeminal nerve is responsible for sensation all around the face including the eyes, mouth and sinus cavities. The pain that is produced usually comes on suddenly and can last from a few seconds to a few minutes, but may be physically and mentally incapacitating. Episodes can be triggered by certain activities that cause a vibration or contact with the cheek, such as shaving, brushing your teeth or applying makeup, as well as eating, drinking or talking. As the condition progresses, the episodes of pain may become longer and more frequent.
Causes of Trigeminal Neuralgia
Trigeminal neuralgia is typically brought on by contact between a normal artery or vein and the trigeminal nerve. It may be the result of a blood vessel pressing on the trigeminal nerve as it exits the brain. The condition occurs most often in people over the age of 50 and tends to affect a larger percentage of women than men. Trigeminal neuralgia may be related to multiple sclerosis or other neurological conditions that damage the myelin sheath that protects nerves. Although less common, trigeminal neuralgia may be caused by a tumor on the trigeminal nerve as well.
Trigeminal Neuralgia Diagnosis
A diagnosis of trigeminal neuralgia can be made with both a thorough medical history and certain forms of testing. Initially, your physician will likely ask you many questions about the pain you are experiencing, including a description of how it feels, where it tends to occur and what seems to trigger the pain.
A neurological exam can be helpful in both ruling out a number of other disorders and specifying the part of the trigeminal nerve that is responsible for the problem. It may also include testing of the reflexes to assess whether there is pressure being placed on a nerve. To accurately determine the diagnosis, Dr. Lipani may additionally recommend various blood tests and imaging methods such as an MRI of your head.
The Microvascular Decompression Procedure
Microvascular decompression is a surgical procedure performed to reduce the amount of pressure being placed on the trigeminal nerve. It is used when medications and other conservative methods of treatment cannot effectively relieve the symptoms of trigeminal neuralgia.
This procedure is performed under general anesthesia. The patient’s head is properly positioned and held in place by a fixation device. The treatment site is swabbed with antiseptic and a small amount of hair is shaved. An incision is made in the skin to expose the bones of the skull. Dr. Lipani then uses special tools to cut an opening in one of these bones and temporarily remove it in order to access the trigeminal nerve near the brainstem. The dura tissue that covers the brain is opened. A small bit of sponge material will be placed in between the nerve and the blood vessel, vein or artery that has been compressing it. If necessary, the problematic structure will be repositioned or removed. This can alleviate the pressure on the affected nerve and the accompanying pain and symptoms.
Once the microvascular decompression is completed, Dr. Lipani will seal and suture the dura. The skull bone that had been removed will either be replaced and reattached or a small titanium plate will be affixed using screws. The skin is then stitched closed over the area.
Recovery from Microvascular Decompression
Most patients spend one to two nights in the hospital following a microvascular decompression procedure. Headaches are common after this surgery, but they typically respond well to prescription pain medication and decrease within a few weeks. Patients also frequently experience fatigue for some time. Activities may be restricted initially and Dr. Lipani will inform you of when you can resume your normal daily routine based on your personal healing and recovery process.
Risks of Microvascular Decompression
All surgery carries some form of risk. The complications that are associated with microvascular decompression include nerve damage, vision disturbances, hearing loss, facial paralysis, seizures, bleeding and infection. Dr. Lipani will discuss these risks with you prior to the procedure and take precautions to prevent any complications from occurring while performing the microvascular decompression.