Trigeminal neuralgia causes sudden, electric-shock pain on one side of the face, often set off by chewing, brushing the teeth, talking or even a breeze. In many people a blood vessel presses on the nerve where it leaves the brainstem. Medicines work at first, but often become less effective or cause side effects. Surgery then offers other ways to relieve the pain.
Who it may help
- Brief, severe, stabbing facial pain several times a day
- Pain that no longer responds to carbamazepine or similar medicines
- Side effects from medicines such as drowsiness, liver changes or memory problems
- Pain that interferes with eating, sleep or mood
- A diagnosis made by a neurologist or neurosurgeon
Conditions treated
- Classical trigeminal neuralgia
- Atypical trigeminal neuralgia
- Trigeminal neuralgia in multiple sclerosis
- Post-herpetic facial pain
- Glossopharyngeal neuralgia
- Pain returning after earlier procedures
Treatment options
- Microvascular decompression (MVD) An operation behind the ear that moves or cushions the blood vessel pressing on the nerve. It treats the cause and aims to preserve normal facial sensation.
- Percutaneous radiofrequency rhizotomy A needle-based procedure using controlled heat to quieten the pain fibres.
- Balloon compression A small balloon is briefly inflated near the nerve.
- Glycerol injection A guided needle places glycerol near the nerve.
- Radiosurgery Focused radiation, arranged through a partner centre for selected patients.
Before the procedure
- MRI of the brain, often with special sequences to look at the nerve and nearby vessels
- Mapping of the pain and its triggers
- Medical fitness for anaesthesia
- Discussion with a neurologist and, where useful, a pain specialist
Recovery: what to expect
- MVD: about 3 to 4 days in hospital, and light activities within roughly a week.
- Needle procedures: day-care or one night in hospital, with recovery in a few days.
- Pain relief can be immediate after MVD and more gradual with other methods.
- Follow-up at 2 weeks, 1 month and then every few months.
These are typical timings. Your own plan depends on your condition, your general health and the operation chosen, and Dr. Chakraborty will go through it with you.
Risks to know about
Every operation carries risk. The ones most relevant here are:
- Facial numbness, more common with needle procedures and radiosurgery
- Hearing loss, a leak of brain fluid or infection after MVD
- Pain returning after months or years
- Rarely, bleeding or a stroke-like event
Your own risks depend on your health and your scans, and are explained in detail before you decide on anything.
Common questions
Can the pain be cured?
Many people get long-lasting relief, particularly after MVD. A cure cannot be promised in every case.
What is the chance of relief with MVD?
Most people have complete or significant relief. The likelihood for you depends on your scan findings and is discussed in clinic.
Is MVD risky?
It is major surgery with real but uncommon risks, which are explained in advance.
Could the pain return?
A proportion of people have a recurrence after years. Other options are available if that happens.
This page is general information to help you prepare for a consultation. It is not medical advice and does not replace an examination. Every plan is made for the individual patient.