Trigeminal neuralgia (TN -- tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw and lower jaw. A less common form of the disorder called atypical trigeminal neuralgia may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50.
Most patients initiate their medical treatment by seeing a neurologist. A neurologist may prescribe anti-seizure medications (Tegretol, Dilantin, and Neurontin, to name a few) which can control the pain. When a patient has tried and failed medical therapy he or she may be sent to a neurosurgeon for evaluation and further treatment.
Microvascular decompression is the surgical procedure with the greatest success rate and the longest lasting relief of pain. This is an operation involving an opening in the skull, just behind the ear. The neurosurgeon finds where the trigeminal nerve is exiting the brain stem and usually finds a blood vessel in contact with the nerve. The blood vessel is moved out of contact and a piece of Teflon wool (padding) is inserted to protect the nerve from the blood vessel.
This is the only surgical option that does not leave the patient with residual facial numbness. Other surgical options include percutaneous destructive procedures to injure the trigeminal nerves such as ballon compression and radiofrequency lesioning. Radio surgery is another destructive procedure that can be used in patient that cannot tolerate anesthesia. All of these alternative procedures leave the patient with some degree of numbness.