Surgery offers relief for face pain

July 18, 2011 9:57:22 AM PDT
Imagine pain striking your face so severely it stops you from eating, talking, or even moving.

Trigeminal neuralgia is the most common craniofacial pain syndrome. This chronic pain condition affects the trigeminal nerve.

People affected may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. Trigeminal neuralgia affects women more often than men, and it's more likely to occur in people who are older than 50. Trigeminal neuralgia may run in families. (Source: Columbia University Medical Center, Department of Neurological Surgery)

CAUSES: Doctors aren't exactly sure what causes trigeminal neuralgia. However, there is considerable evidence that vascular compression of the trigeminal nerve near the brainstem is the cause. This may be due to branches of the superior cerebellar artery, basilar artery, or local veins compressing the trigeminal nerve. Additionally, trigeminal neuralgia can be caused by tumors in the region of cranial nerve V or by multiple sclerosis.

SYMPTOMS: Trigeminal neuralgia pain is classically described as "stabbing" or "electrical shock-like." Episodes are usually brief, lasting a second or two, but can be unbearable. They usually occur on one side of the face, but in rare cases, they may be two-sided.

Painful attacks may occur spontaneously but are more often associated with a specific stimulus in a "trigger area." Common trigger points are the eyebrow, the upper lip, and the lower molar teeth. Sensory stimuli by touch, cold, wind, talking or chewing can trigger the attacks.

Pain-free intervals last for minutes to weeks, but long-term spontaneous remission is rare. The attacks stop during sleep but often occur when awoken in the morning.

THE CURE: The primary treatment of trigeminal neuralgia is pharmacological. However, if pharmacologic management is ineffective, surgical intervention is required. The first-choice treatment is microvascular decompression surgery (MVD). It involves surgically opening the skull and exposing the nerve at the base of the brainstem to insert a tiny sponge between the compressing vessel and the nerve. This sponge isolates the nerve from the pulsating effect and pressure of the blood vessel. By removing the compression, the painful symptoms are relieved. (SOURCE:


Joanne H. Nicholas
Director, Public Affairs
Continuum Health Partners
(212) 523-7772

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