In this procedure for patients with trigeminal neuralgia and some other types of facial pain a needle is directed (under anaesthesia) from the cheek into a small opening in the base of the skull. Just through that opening the trigeminal nerve sits before it divides to provide sensation to the different parts of the face.
The needle is guided into the opening using x rays. When the needle is in place the patients anaesthetic is lightened and this allows the surgeon to test where the patient feels a tingling sensation in the face. Once the tingling sensation is in the same place as the patients pain the patient is anaesthetised more deeply and the nerve is carefully damaged. The damage is from the tip of the needle, which heats up to an exact temperature, for a specified time. The damage gives treatment of the facial pain whilst preserving the normal function of the nerve. Patients usually have slight numbness in the area where the pain used to be and sometimes have some weakness to the chewing muscles.
The treatment takes about 15-30 minutes and can be repeated in the future if the trigeminal neuralgia returns.
Benefits of treatment: Pain is treated in 80-90% of patients with typical trigeminal neuralgia but in less patients with atypical pain. The treatment is durable in some patients but recurs in more than 50% of patients at some point during a 10 year period (sometimes after shorter periods of time).
Evidence for treatment: Thousands of patients have had this treatment in trials with effective treatment of symptoms. The treatment is low risk and effective but many patients will have a relapse of symptoms at some point. If this occurs the procedure may be repeated, in some cases, on multiple occasions.
Risks of treatment: The most serious risks include deep brain infection and stroke. These risks are present in 1-2% of patients. Another serious complication is that the patient experiences severe numbness of the face with a terrible type of burning pain called ‘anaesthesia dolorosa’. This complication is terrible, unusual and difficult to treat but thankfully occurs rarely though in some studies has been reported in up to 5% of patients.
Post operatively patients are monitored for several hours. If pain is well controlled and the patient is safe to do so they can usually return home the same day as the procedure takes place. Normal activities including driving can be commenced the day after the procedure if the patient remains well.
If the neuralgia is well controlled after the procedure then medications to treat trigeminal neuralgia can be gradually weaned over a period of weeks to months depending on the doses of medication the patient is taking. I will give you advice regarding this step.
I will see you 6 weeks after the procedure to see how the treatment has progressed. If the pain returns or you have concerns after the procedure please contact me via my private practice rooms.