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.
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.
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.