Surgery for Trigeminal Neuralgia

If medication alone does not stop the pain caused by trigeminal neuralgia, specialists at NYU Langone may recommend surgery. Our physicians are highly trained in neurosurgical procedures to reduce or eliminate trigeminal neuralgia pain. Depending on the type of pain you are experiencing, your doctor may perform one or more of the following techniques.

Percutaneous Procedures

In percutaneous procedures, the doctor uses a needle to reach the affected part of the trigeminal ganglion—a mass of nerve cells that are part of the trigeminal nerve. Various methods can then be used to destroy a portion of the trigeminal ganglion, eliminating the source of pain. 

Percutaneous procedures are often the preferred method of treatment for people with multiple sclerosis, older adults, or those who have recurrent pain following a more invasive surgical procedure. NYU Langone specialists offer three types of percutaneous procedures.

Glycerol Injection

In this surgery, a surgeon inserts a needle through the cheek and into the base of the skull. The needle is guided into the spinal fluid that surrounds the trigeminal nerve, and a small amount of sterile glycerol (alcohol) is injected into the fluid. The glycerol damages the nerve signals, blocking the pain. 

This procedure often relieves pain immediately. However, some people may have lasting facial numbness or tingling, or they may experience a later recurrence of pain. Most people report that the numbness is more tolerable than the pain they were previously experiencing. NYU Langone doctors may prescribe medication to minimize any discomfort or side effects.

This type of outpatient surgery requires sedation, and most people go home the day of treatment.

Balloon Compression

In balloon compression surgery, your surgeon uses a hollow needle that is threaded with a thin, flexible tube with a balloon on the end. He or she inserts the needle through the cheek and back of the mouth to the trigeminal nerve, then inflates the balloon with enough pressure to damage the nerve and block pain signals. 

Some people have facial numbness after this procedure. Others may experience temporary or permanent weakness of the muscles used to chew. Your doctor may prescribe medication to minimize discomfort or side effects.

This type of outpatient surgery requires general anesthesia. Most people can go home the same day, but some may have to stay in the hospital overnight.

Radiofrequency Thermal Lesioning

In radiofrequency thermal lesioning, a surgeon inserts a hollow needle fitted with an electrode through the cheek and positions it at the affected part of the trigeminal ganglion. A mild electrical current is sent through the tip of the electrode to damage the appropriate nerve fibers.

For most people, this effectively relieves the pain, although some are left with facial numbness or tingling after the procedure. Many people have noted that this numbness is much more tolerable than the pain associated with trigeminal neuralgia. Your doctor can prescribe medication to minimize any discomfort or side effects from the procedure.

This surgery is an outpatient procedure and requires local anesthesia.

Gamma Knife Radiosurgery

A minimally invasive technique, gamma knife radiosurgery allows doctors to direct radiation at a small target inside the head. In conjunction with MRI or other high-resolution computer imaging, the surgeon directs highly focused beams of radiation at the site where the trigeminal nerve exits the brain stem. This causes a lesion to slowly form on the nerve, eventually disrupting the transmission of sensory signals to the brain. 
It may take several weeks to feel relief from pain, although some people experience relief within a day or two. In our doctors’ extensive experience with this procedure, approximately 10 percent of people experience some loss of sensation in the face. The procedure may need to be repeated if pain recurs.

This type of outpatient surgery requires light sedation. Gamma knife radiosurgery is recommended for older adults, people with multiple sclerosis, and those who have recurrent pain following a more invasive surgical procedure.

Microvascular Decompression

If MRI scans identify the source of your facial pain as a blood vessel pressing on the trigeminal nerve, your doctor may recommend microvascular decompression surgery in which the surgeon relocates or removes blood vessels. 

In this procedure, the surgeon makes an incision behind the ear on the side of the head where pain is occurring, making a small opening in the skull. He or she then moves the blood vessels away from the trigeminal nerve and places a pad between the nerve and the arteries. If a vein is compressing the nerve, the doctor may remove the vein entirely to relieve pressure on the trigeminal nerve. 

Microvascular decompression eliminates or reduces pain almost immediately. Although trigeminal neuralgia pain may return months or years later in a certain percentage of people who undergo any of the surgical procedures detailed above, many of those who have had microvascular decompression have no facial numbness afterward. 

This type of surgery requires general anesthesia. The procedure takes a few hours, after which you are monitored in the hospital. Most people stay in the hospital for a few days following surgery and return to their daily activities within a month.

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