What is Trigeminal Neuralgia And How Can It Be Treated?

May 6, 2022

Neurosurgery is a highly precise field used to treat several conditions that are often life-threatening or life-altering, with the aim of using minimal interventions to create huge differences.

The disorder trigeminal neuralgia is the latter, but it can also be a life-halting for over 355,000 people who experienced the disorder with episodes of debilitating facial pain.

Thankfully, trigeminal neuralgia treatment with Gamma Knife surgery, can minimise the painful episodes it causes.

Trigeminal neuralgia was first described by John Fothergill in 1773 as a sudden, sharp facial pain that many patients compare to an electric shock to the gums, teeth or jaw.

Due to the level of pain, the unexpected nature of episodes and the long-lasting physical and mental effects TN can have, it has unfortunately been referred to as the “suicide disease”, after a Harvey Cushing study reported on 123 cases between 1896 and 1912.

The trigeminal nerve, which gives the disorder part of its name, is the nerve responsible for biting and chewing, which is often triggered by eating or light touch.

This unfortunately can lead to the condition being misdiagnosed as a more benign but still painful condition such as temporomandibular disorder (TMD), a dental condition that causes pain in the jaw or ear but often goes away on its own or with the help of a retainer.

On the other hand, trigeminal neuralgia is a nerve disorder that needs to be differentiated from TMD and other conditions caused by chewing and biting, such as a cracked tooth or infection.

Some dentists diagnose it this way by using a local anaesthetic that blocks TN but not other masticatory pain.

Once TN has been discovered, the next step is treatment. Often the first-line treatment will be the anticonvulsant medication carbamazepine, which is also used to treat epilepsy, with other alternative medicines available if this does not work.

However, if the anticonvulsant medicine is ineffective or causes major side effects, there are also surgical treatments that can potentially help if a medication cannot.

These are divided into those that damage the nerve at a precise point to stop it from causing pain and others that relieve pressure and pain.

The main surgical intervention was microvascular decompression, an invasive surgery which involves making an incision behind the ear and placing a pad between the compression area and nerve to stop it from causing pain responses.

Whilst effective, it is also an invasive surgery, requiring general anaesthetic and a long period of recovery.

However, an increasingly popular treatment is stereotactic radiosurgery, also known as Gamma Knife surgery, which can be done without anaesthetic, without any incisions, and as an Outpatient without any hospital stay and minimal recovery time.