Trigeminal neuralgia is one of the most painful diseases known to mankind. Initially, it appears as a momentary facial pain, but as the cycle becomes shorter and the pain intensifies, it becomes difficult to perform basic daily activities such as washing face, brushing teeth, eating, makeup, and shaving. However, since it is a disease that is not easily accessible in the vicinity, patients often do not even know which department to go to and which treatment is effective. Because trigeminal neuralgia treatment is very closely related to the patient’s quality of life, it is most important to consult with an experienced medical professional who can clearly explain the pros and cons of various treatments based on an accurate diagnosis. An interview was conducted with Professor Park Bong-jin of the Neurosurgery Department of Kyunghee University Hospital.
– What is trigeminal neuralgia?
The trigeminal nerve is a cranial nerve that transmits pain and temperature sensations from the face and head to the brain. Trigeminal neuropathy refers to a disease in which pathological changes in the trigeminal nerve cause facial paresthesia and weakening of the chewing muscles. If the main symptom of trigeminal neuropathy is pain, it is called trigeminal neuralgia. Trigeminal neuralgia is a relatively common cranial neuralgia, with an annual incidence of 4.5 per 100,000 people. It is relatively common in middle-aged and older women.
– What are the causes of trigeminal neuralgia?
The most common cause of trigeminal neuropathy is trauma. When a severe shock is applied to the base of the skull, the trigeminal nerve, which passes through the complex base, is often damaged along with other cranial nerves and related structures. Among infectious diseases, the most common cause of trigeminal neuropathy is herpes zoster. Otitis media or petrous bone apex infection may spread to the ganglion or nerve root and invade the trigeminal and abducens nerves simultaneously. It may be caused by compression of the trigeminal nerve by various tumors in the base of the brain, or pathological changes in the cavernous sinus or superior orbital fissure through which the trigeminal nerve passes.
– How severe are trigeminal neuralgia symptoms?
Common symptoms of trigeminal neuropathy begin with decreased facial sensation and weakened chewing muscles. Decreased function of only the trigeminal nerve is rare, and it is often accompanied by dysfunction of other adjacent cranial nerves. Most trigeminal neuralgia appears unilaterally (unilaterally) in the dominant region of the 2nd and 3rd branches of the trigeminal nerve. Severe pain, like being stabbed with a sharp awl or a knife, appears suddenly as if a strong electric current is passing through it and lasts for a few seconds to 2 minutes and then improves. These seizures rarely occur during sleep.
Trigeminal neuralgia causes severe, unbearable pain. This will cause your face to twitch for a moment. This is called a tic douloureux. The pain may appear spontaneously or may be triggered when talking or chewing food. Also, touching any part of the face can cause pain, which is called a trigger point. It mainly occurs in the maxillary and mandibular branches, and sometimes it appears in a location completely different from the actual pain site. Other sensory functions are usually normal.
– How is trigeminal neuralgia diagnosed?
Trigeminal neuropathy cannot be confirmed through objective tests such as imaging tests or blood tests. Since the diagnosis depends on the patient’s symptoms and pain pattern, it is necessary to know the characteristics of trigeminal neuralgia accurately. Pain is caused by innocuous stimuli such as eating, washing, brushing teeth, or talking. Lightning-like pain occurs along the trigeminal innervation area. Pain lasts from a few seconds to a few minutes. When the stimulus disappears, the pain disappears. If no abnormalities are found to explain the pain, a detailed neurological examination is performed. Trigeminal neuralgia can be suspected if the results of head and neck examination are normal, there is no neurological abnormality, and periodic unilateral facial pain is complained even with painless stimulation. It should be differentiated from periodontal infection, sinus disease, otitis media, acute glaucoma, temporomandibular joint disease, and herpes zoster.
– How is trigeminal neuralgia fundamentally treated?
Existing trigeminal neuralgia treatments such as drug therapy, botox treatment, nerve block, alcohol injection, radiofrequency nerve treatment, and surgery are diverse. Most patients tend to prefer treatments other than surgery because the burden of general anesthesia and brain surgery is high. However, the most effective treatment is microvascular decompression because it is a temporary pain relief rather than a cure through resolving the root cause, and the risk of recurrence is very high.
It is a high-level surgery that removes and separates blood vessels that compress the nerves and inserts a buffer material called Teflon between the nerves and blood vessels to reduce the pressure so that the heartbeat of the blood vessels is not transmitted to the nerves. For this, the surgeon’s high concentration, sophisticated skills, and rich experience are essential. The success rate of microvascular decompression for trigeminal neuralgia is about 80-90%, and the recurrence rate within 10 years is about 20%. The success rate of microvascular decompression surgery for hemifacial spasm is 95% and the recurrence rate is around 3%, showing superior results compared to other treatments.
Patient satisfaction is also very high because the treatment response appears immediately after surgery. As long as you avoid activities that increase brain pressure, such as blowing your nose or standing on your hand, you can lead a normal life right after surgery without any special precautions. Kyung Hee University Hospital has performed more than 4,500 microvascular decompression procedures so far, and the postoperative complication rate is less than 3%.
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