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What is trigeminal neuralgia?

Trigeminal neuralgia is a condition of the trigeminal nerve, located in the central nervous system, which causes severe pain in the face. The pain is usually episodic and, although it can occur throughout the face, the area most often affected is the jaw.
 
The trigeminal nerve, also known as the fifth nerve, is divided into three branches from the base of the skull. When any of the points is compressed, it releases a sudden burst of stabbing pain in all or some of the areas supplied by the branches of the trigeminal nerve: upper and lower jaw, nose, cheekbones and chin. It can even affect the forehead, although this is rare.

Although the episodes tend to be brief, usually lasting a matter of seconds, they can come at any time, caused by different movements or friction, negatively affecting the patient’s quality of life. At Instituto Clavel, we offer treatments to eliminate, or at least significantly reduce, these discomforts.

Causes of trigeminal neuralgia

In most cases, this condition is due to the superior cerebellar artery crossing over the trigeminal nerve, located in the lower compartment of the skull (posterior fossa), placing pressure on it. This pressure can also be produced by other blood vessels located next to the trigeminal nerve, when the distance between them is reduced due to anatomical variations or abnormal growth, and compression results. 
 
Although less frequent, trigeminal neuralgia can also be related to infection with the Herpes-Zoster virus, tumors or multiple sclerosis.

Symptoms and diagnosis of trigeminal neuralgia

SYMPTOMS

The main symptoms of trigeminal neuralgia are attacks of sharp, stabbing pain, lasting from a few seconds to two minutes. These are very intense and can be produced spontaneously by various natural actions of the patient, such as talking, laughing, chewing, swallowing, brushing your teeth, or just brushing your face against something.
 
Since it is intense pain that can be so easily triggered by normal activities, this condition can seriously restrict the patient's life if it recurs throughout the day. There have even been cases of patients losing weight because they avoid eating and drinking for fear of the pain it might cause.

DIAGNOSIS

Not all sudden pain in the face is necessarily caused by trigeminal neuralgia. To diagnose it correctly, it is important for medical professionals to rule out other conditions that can generate facial pain, such as dental problems, problems in the nostrils or eyes, muscle tension in the neck area, headache, or diseases affecting the maxillary joint.

If trigeminal neuralgia is considered to be the most likely reason for pain, the doctor will need to determine whether it is classic or symptomatic neuralgia, that is, whether it has appeared as a consequence of another disease. 

For this, it is usual to do an MRI of the patient’s head with which it will be possible to check if there is damage to the nerve, if there is a tumor or if there are signs of other diseases such as multiple sclerosis.

At Instituto Clavel we have a team of professionals with extensive experience and the latest technology to guarantee a correct diagnosis, with a process that is as simple as possible for the patient. 

Treatment

There are several treatment options for this condition.

Medication

The most common is to begin by treating the problem with medication, carbamazepine being the medication usually prescribed. However, when it fails to prove effective, or does not give sufficient relief, there are other alternatives.

Microvascular decompression

At the Instituto Clavel, the first choice is usually microvascular decompression, a permanent neurosurgical technique, that is widely accepted and has a high success rate. This helps to eliminate the main cause of trigeminal pain, which is the contact of this nerve with the superior cerebellar artery.
 
Microvascular decompression is performed by making a small opening in the skull behind the ear to insert prosthetic material between the artery and the nerve. This material acts as a cushion on the affected nerve and can eliminate or significantly reduce the pain. We have neurosurgeons who are experts in this type of intervention, so we have a very high rate of good results.

Other techniques

However, there are other techniques available for those patients who cannot undergo microvascular decompression because of high surgical risk or because the neuralgia has its origin in some other cause, such as the Herpes-zoster virus. The main alternative treatments are radiofrequency and balloon compression of Gasser's ganglion, which is part of the trigeminal nerve.
 
These techniques are performed under sedation, making a puncture through a hole at the base of the skull, assisted with intraoperative x-ray guidance. While not as effective as long-term microvascular decompression, they can provide significant pain relief, and are a good alternative for cases like elderly patients, or when some other circumstance makes a favorable response to microvascular decompression unlikely.
 
At Instituto Clavel we have experts and new generation systems to carry out these types of procedures with optimal results for the treatment of trigeminal neuralgia in all its stages.

Preparation, Empowerment, and Recovery (PER) program

In addition, we have a patient Preparation, Empowerment, and Recovery (PER) program with protocols adapted to all stages of the process, which allow us to guarantee the best results.

Evolution and recovery from trigeminal neuralgia

The evolution of the condition will depend on the treatment chosen and how advanced it is. In initial stages, it is possible that the episodes of pain are separated by weeks or months. In many cases these can be controlled by following an appropriate treatment for the patient.

In the event that the pain continues despite medication, and other treatments such as microvascular decompression or radiofrequency need to be considered, at the Instituto Clavel patients will receive the necessary support from the team's professionals before, during and after the process to facilitate your recovery.

Who are the doctors at Instituto Clavel who treat trigeminal neuralgia?

The Instituto Clavel cranial and cerebral surgery team will carry out the surgical evaluation and management of the pathology. 

Sources

  • M.S. GREENBERG. Handbook of Neurosurgery. Cap. 16.2.1. Trigeminal neuralgia. Ed.Thieme.
  • L.N. SEKHAR. Atlas of Neurosurgical Technique (Cranial). Cap 72. Microvascular Decompression for Cranial Nerve Compression Syndrome. Ed. Thieme.

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