Trigeminal Neuralgia

Dr. Muhammed Ziya

Trigeminal Neuralgia is a serious health condition.

Transcript

00:00Trigeminal neuralgia is a very serious condition.

00:04It's a pain disorder that affects the face.

00:08And most of the time this is actually caused by a blood vessel that compresses

00:12against a cranial nerve that's called the trigeminal nerve.

00:16The trigeminal nerve provides all the information that processes the touch

00:20information on our forehead, our eye, our cheeks, our mouth, back to the brain.

00:26Every case has a unique anatomy, but in many cases, the artery has a long loop.

00:33And that loop can sometimes get stuck right where the nerve comes out of the brain stem.

00:38And when that loop of the artery gets stuck there, it can wear down the lining on the

00:42nerve and then make that part of the nerve very raw.

00:44That injury to the nerve, that compression over time is actually what causes the pain.

00:49One of the most important surgical treatments for trigeminal neuralgia is called a

00:53microvascular decompression.

00:55During this procedure, a small incision is made behind the ear, about two inches long.

01:01We then use a drill to actually drill out a piece of the bone about the size of a nickel.

01:06And through that hole, we actually use an operating microscope to see where the nerve is coming

01:11out of the brain stem and to dissect the artery off that nerve.

01:16Now even though this is a kind of brain surgery, there is no cutting of any brain tissue itself.

01:22All we primarily do in the surgery is separate the artery from the nerve without trying to

01:27go through or injure any brain tissue.

01:30That procedure is about 80 to 90 percent effective in stopping trigeminal neuralgia pain.

01:35And it usually happens immediately.

01:37Another important treatment for trigeminal neuralgia is called radiosurgery.

01:40Radiosurgery is a way of delivering very focused radiation just to the nerve itself.

01:45The goal is to block the transmission of that pain information in that nerve.

01:51It's an outpatient procedure where patients get to go home the same day of their treatment.

01:56At UCSF, we offer two types of radiosurgery.

01:59One is called GammaKnife and the other is called CyberKnife.

02:03Both of these allow very targeted focused radiation to treat the trigeminal nerve.

02:08We offer both of these.

02:09However, over time, we've found that the GammaKnife has been a much more reliable treatment

02:13option.

02:14Patients have had much better pain control with much less side effects.

02:17So at this time, we prefer using GammaKnife for treatment of trigeminal neuralgia.

02:21However, it's not typically as effective as the microvascular decompression.

02:26We typically estimate that about 60 to 70 percent of patients will become pain free after this

02:30procedure.

02:31And the recurrence rate for trigeminal neuralgia is higher from GammaKnife than it is for the

02:36microvascular decompression.

02:38About 50 percent of patients at five years will have recurrence of their facial pain.

02:43The third surgical treatment for trigeminal neuralgia is called radiofrequency lesioning.

02:48Radiofrequency lesioning is done by introducing a needle probe actually through the cheek, the

02:53side of the mouth.

02:55We use x-rays during the surgery to guide that needle to the base of the skull.

03:01And the needle is very gently and delicately introduced through a hole at the bottom of

03:06the skull called the foramen ovale.

03:09The foramen ovale is a part of the skull where the trigeminal nerve has branches that exits

03:14the skull.

03:15And it's through that opening that we can actually introduce the nerve probe to an important

03:20part of the trigeminal nerve called the trigeminal nerve ganglion.

03:24The radiofrequency works by introducing heat.

03:28And it heats up an injurious part of the nerve that helps desensitize the nerve.

03:33And through that it actually interrupts the transmission of pain information from the face.

03:39One of the big differences between radiosurgery and radiofrequency lesioning is that the radiosurgery

03:45is very non-invasive.

03:47It's actually not a surgical procedure.

03:48It's a radiation treatment.

03:50It has about 20 to 30 percent chance of having facial numbness.

03:55But it may take time for the benefit to actually kick in.

03:58On the other hand, the radiofrequency effects typically control the pain right away.

04:03But in almost all cases, it's associated with causing some facial numbness.

04:08Overall, all of these procedures are very effective at treating trigeminal neuralgia.

04:13In some cases, the pain can come back after several years.

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