Other treatments
for trigeminal neuralgia
As well as Gamma Knife stereotactic radiosurgery, the following treatments are available:
- Medications
- Non-pharmaceutical, surgery options
- Microvascular decompression
- Percutaneous procedures.
Medications
Medications are prescribed to lessen or block pain signals to the brain. This is usually the first treatment approach. Medicines can include anticonvulsants (medicines used to treat epilepsy). Carbamazepine or oxcarbazepine are commonly prescribed. Others such as lamotrigine, phenytoin, clonazepam or gabapentin are also prescribed. The choice of medicine depends on how well the patient tolerates the side effects and interactions with any other medicines she or he is taking.
Side effects
Microvascular Decompression Surgery
Microvascular Decompression Surgery (MVD) is a major invasive procedure that involves opening the skull. It is carried out under general anaesthetic by a neurosurgeon. The procedure relieves the pressure exerted on the trigeminal nerve by blood vessels that are touching the nerve or are wrapped around it.
MVD surgery carries risks, including decreased hearing, facial weakness, facial hypesthesia or loss of sensation on the face, a stroke or other complications. It is not a good option for patients who have other medical problems or are older in age.
Risks
Percutaneous procedures
Percutaneous procedures (through the skin) to treat trigeminal neuralgia include glycerol injections, radiofrequency lesioning and balloon compression.
The major side effect of these procedures is hypesthesia or loss of sensation in part or all of one side of the face, which can vary from being very numb or just pins and needles.
Patients can also develop a combination of hypesthesia or loss of sensation and continuous pain called anaesthesia dolorosa, yet this is rare.
These procedures also carry a risk of other short- and long-term side effects and complications, including bleeding, facial bruising, eye problems and impaired hearing on the affected side. Very rarely, it can cause a stroke.
Side effects
Neurectomy
A neurectomy (also called partial nerve section), which involves cutting part of the nerve, may be performed near the entrance point of the nerve at the brain stem during an attempted microvascular decompression if no blood vessel is found to be pressing on the trigeminal nerve. Neurectomies also may be performed by cutting superficial branches of the trigeminal nerve in the face.
With neurectomy, there is also a risk of creating anaesthesia dolorosa.
