Trigeminal Neuralgia (TN) Treatment

Once diagnosed with trigeminal neuralgia, the first line of treatment is almost always medical therapy. Medications—including anticonvulsants, muscle relaxants, and tricyclic antidepressants—will relieve the pain in roughly 75 percent of trigeminal neuralgia patients.

Trigeminal neuralgia surgery is an effective treatment for the 25 percent of patients who do not respond to medications or have negative side effects from medications. Knowing about surgical options is also valuable for patients whose pain is currently controlled by medications because trigeminal neuralgia pain can escalate quickly.

Unlike many neurosurgery practices that offer only one type of TN surgery, the Colorado Trigeminal Neuralgia Clinic offers multiple surgical options to treat TN. Our experts treat patients from throughout Colorado, Wyoming, western Kansas, and New Mexico. We also consult on cases throughout the country.

The three types of surgery currently being offered by the Colorado Trigeminal Neuralgia Clinic include:

Radiosurgery (Gamma Knife®)

Utilizing focused beams of radiation, this non-invasive procedure intentionally damages the trigeminal nerve, stopping the nerve from conducting pain signals to the area of short-circuiting. Since the beams are focused on the target, the procedure results in minimal damage to healthy tissue. The procedure is completed in one visit with essentially no recovery time.

  • Outcomes: Up to 96% chance of improvement (Can be repeated, with secondary procedures providing an 89% success rate, even in those whose condition recurred or who failed initial treatment.)
  • Benefits: Outpatient, noninvasive procedure; no anesthesia; virtually no risk or recovery time, other than a 2% chance of permanent numbness (not weakness or sagging)
  • Drawbacks: Delayed pain relief, up to a month or more, but typically within one week; slightly lower success rate than other surgical therapies
  • Ideal Candidate: Most patients with trigeminal neuralgia; in particular, those with relatively good but not great control who are willing to undergo a very low-impact procedure without any recovery time to lessen their pain, their side effects or their need for medication

Gamma Knife can be performed in one day, with patients able to return to work immediately. Dr. Prall performs Gamma Knife stereotactic radiosurgery at the Rocky Mountain Gamma Knife Center and has performed more than 850 Gamma Knife procedures.  

 

Percutaneous Rhizotomy

Guided by X-ray, the surgeon inserts a thin needle through the patient’s cheek into the trigeminal nerve to damage it and stop it from transmitting pain signals to the “short circuit” and on to the brain. The surgeon can damage the nerve by injecting glycerol, burning it with radiofrequency energy, or crushing it with a balloon.

With radiofrequency (PRR), control rates are slightly higher and recurrence rates are slightly lower than with the other needle-based procedures. Although the incidence of numbness is greatest, surgeons use this needle method most often because, on average, it has the most positive effects with the fewest drawbacks.

  • Outcomes: 90–95% cure with 20–25% recurrence
  • Benefits: Outpatient procedure; local anesthesia; immediate relief
  • Drawbacks: Guaranteed facial numbness, with a 1% chance of severe facial numbness or burning pain called “anesthesia dolorosa”
  • Ideal Candidate: Patients who have failed other methods; older patients with anesthesia risks who have such severe pain that they are not eating or drinking adequately

 

Microvascular Decompression

Available since the 1950s, microvascular decompression (MVD) is also sometimes referred to as posterior fossa exploration. In the past, considered the “gold standard” in treatment, MVD is still thought by some to be the only good surgical option for trigeminal neuralgia patients. It involves making a small incision behind the ear and implanting a small felt pad between the blood vessels and the trigeminal nerve to alleviate the pressure and resulting “short circuit.”

  • Outcomes: 90–95% cure with 20–25% recurrence
  • Benefits: Immediate relief; less than a 1% chance of serious complications (in the hands of a surgeon with significant experience); minimal risk of numbness
  • Drawbacks: Inpatient surgery requiring general anesthesia, small surgical risks and a two-day stay in the hospital, with around two weeks of recovery at home
  • Ideal Candidate: Many patients of all ages with limited anesthesia risk; MVD for TN is a safe procedure even in the elderly; the risk of serious morbidity or mortality is similar to that in younger patients

Studies reflecting the above benefits can be found on our research page