Stereotactic Radiosurgery Institute
Trigeminal Neuralgia - Tic Doloreaux
Trigeminal Neuralgia - Tic Doloreaux
- Diagnosis
- Excruciating Facial Pain
- Typically shock like pain
- "Electric Shock"
- "Like cattle prod in my mouth"
- Virtually always on one side.
- Mainly in face
- Along Branches of the Trigeminal Nerve
- V1 (First Branch) Pain shoots to forehead and eye area.
- V2 (Second Branch) Pain shoots to cheek and side of nose, upper gums.
- V3 (Third Branch) Pain shoots to jaw, tongue, lower gums.
- Can involve tongue.
- Can involve inside of cheek.
- Can involve gums.
- Triggers
- Commonly occur with stimulation to the face, mouth, tongue, gums, teeth.
- Attacks can be easily triggered by:
- Eating.
- Talking.
- Shaving.
- Chewing.
- Brushing teeth.
- Wind on face.
- Cold on face.
- Drinking.
- Touching face.
- Touching tongue.
- Touching Gums.
- Causes
- Tumor pressing on Trigeminal nerve.
- Blood vessel pressing on Trigeminal nerve.
- Plaque from multiple sclerosis in nerve or brainstem.
- Idiopathic or unknown cause. These are the most common.
- Tests
- MRI or CT scan is recommended to make sure there is not a tumor pressing on the trigeminal nerve causing the problem.
- Treatments
- Medical
- Medications
- Typically helped with anticonvulsants (medications used to treat seizures.)
- Examples are: Trileptal, Tegretol, Neurontin, others.
- Medical treatment is usually recommended for treatment as long as possible. If the patient has an adverse reaction to the medications, the medication can be discontinued and typically the adverse reaction resolves. With surgery, adverse reactions frequently are more difficult to deal with.
- Surgical
- Craniotomy
- Janetta procedure or microvascular decompression (MVD).
- Craniotomy or craniectomy (opening in skull) performed.
Trigeminal Nerve identified and the anterior inferior cerebellar artery (AICA) moved away from the nerve.
Teflon sponge placed between the nerve and artery to prevent the artery from hitting against the nerve with each heartbeat.
If successful, tends to relieve pain immediately or shortly after surgery for a long time without causing facial numbness.
Possible Risks: Risks due to general anesthesia, bleeding, infection, leakage of cerebral spinal fluid, facial numbness, Anesthesia dolorosa (numbness and burning pain), incoordination, loss of balance.
- Percutaneous Rhizotomy
- Under sedation, needle is inserted through the cheek to the opening in the skull next to the trigeminal nerve.
A lesion is med in the branch of the nerve using different techniques.
- Radiofrequency
- A wire is inserted and the nerve is burned with a radiofrequency electrical signal.
- Injections
- A chemical is injected to cause some nerve damage.
- Balloon
- The nerve is injured by crushing it when a balloon inserted through the needle is inflated.
- If successful, tends to relieve pain immediately or shortly after the procedure. Should expect to feel at least partial numbness in the distribution of the nerve treated if the procedure is a success. Typically relief tends to last 2-3 years and the procedure can be repeated if the pain returns.
Possible risks: Anesthesia dolorosa (numbness and burning pain), facial numbness (usually temporary), may not be able to guide the needle to the nerve.
- Radiosurgery
- Large dose of focused radiation delivered to Trigeminal Nerve
- Done with various machines
- Gamma Based most common and most experience
- Rotating Gamma System
- Gamma Knife
- LINAC
- Modified Accelerator
- Dedicated Accelerator
- Robotic
- If successful, tends to relieve pain over a 2-3 month period in most patients without causing facial numbness.
Possible Risks: Facial numbness (usually temporary), Anesthesia dolorosa (numbness and burning pain), incoordination, loss of balance.
- Special Note: Risk of facial numbness may lead to permanent eye damage if not properly cared for.
- If numbness develops in the eye, the patient needs close supervision and treatment by an ophthalmologist. Usually, if any dust or debris get into the eye, people will start tearing and closing the eye to protect it. With numbness, this normal response may be absent causing damage, and eye infections. If this is not treated properly, the loss of an eye and blindness on that side may result.