Sometimes it is mistaken for a dental problem, which is why many people do not immediately seek proper care. We are talking about trigeminal neuralgia, also called tic pain.
People who suffer from it feel intense facial pain, as if it were a small electric shock, due to the involvement of the nerve responsible for carrying the sensitivity of touch and pain from the face to the brain.
But what is the famous trigeminal nerve?
It is formed by the upper or ophthalmic branch, which carries the sensitivity of the scalp, the front part of the head and the face (including the eyes, hence its name); then there is the middle branch that passes through the cheek, the nose and the upper lip; and the lower or mandibular branch, which involves the lower jaw and lip.
In simpler words, it is one of the 12 cranial nerves that originate at the base of the brain.
So what are the causes of trigeminal neuralgia?
As a doctor I must say that many times no cause is found that originates it (idiopathic) and other times it is because a blood vessel compresses the trigeminal nerve when it leaves the brain stem.
In a few cases, it could even be due to local pressure generated by a tumor.
On the other hand, people with multiple sclerosis can present this condition if, due to the nervous degeneration of the disease, the trigeminal nerve is impacted.
How is trigeminal neuralgia diagnosed?
Many general practitioners are completely unaware of this condition, but its prevalence has been increasing as life expectancy rises, constituting up to 89% of facial neuralgia in people over 60 years of age. Therefore, the ideal is to receive specialized care.
In order to diagnose it, a physical and neurological examination is performed to obtain a complete clinical picture. In addition, there are complementary studies such as tomography and brain MRI to differentiate between essential or secondary neuralgia.
However, after diagnosis, there are two forms of treatment: pharmacological (for pain control from strong medications such as those used to treat epilepsy) and surgical.
When we talk about a surgical treatment it is important to understand that there is no single option, but microvascular decompression is undoubtedly the best as it is non-destructive and focuses on relieving pressure on the trigeminal nerve.
The other interventions such as glycerol injection, radiofrequency or radiosurgery involve the destruction of the nerve.
Microvascular Decompression: What is it?
This procedure is ideal for cases that do not respond positively to drugs or when the side effects of taking medications are severe.
Basically, microvascular decompression involves the relocation or removal of blood vessels that are in contact with the trigeminal root. This stops the “malfunction” of the nerve.
For this, as a doctor, we make an incision behind the ear where the pain occurs. Then, through a small hole in the skull, we move away the arteries that are in contact with the nerve, and we place a soft patch between the nerve and the arteries.
Also, if a vein is compressing the nerve, we can remove it.
Finally, it is also possible to cut a part of the trigeminal nerve (neurectomy) during this procedure if the arteries are not pressing on the nerve.
What is achieved with this treatment? Why is it so recommended?
Because it successfully eliminates or reduces pain most of the time.
Of course, it is worth clarifying that the pain can return in some patients.
And, for transparency and ethics, it is also necessary to indicate that microvascular decompression has some risks. It could, for example, decrease hearing, cause facial weakness, facial numbness, or other complications. But each patient is unique and different, so it is best to speak directly with the doctor and assess all the options to receive the most appropriate treatment.
If you have questions, contact me. It will be an honor to serve you.
