Neurosurgical Conditions - Trigeminal Neuralgia

This is an unusual condition, which may be treated by GPs, neurologists, or neurosurgeons. It is characterised by a severe spasmodic and lancinating pain, which affects one part of the side of the face. The pain can be excruciatingly severe and may be triggered by various actions, including chewing, swallowing, drinking hot or cold liquids, brushing the teeth, or being exposed to a cold wind.

The exact cause of the symptoms is not precisely known, but the pain usually affects one branch of the trigeminal nerve which supplies sensation to the side of the face. In many cases symptoms seem to be related to a loop of a blood vessel within the brain itself pressing on the trigeminal nerve. Such loops can sometimes be seen using magnetic resonance imaging.

Treatment
Trigeminal neuralgia can often be adequately controlled with drug treatment alone, for instance Carbamazepine (Tegretol). If, in spite of large doses of medicine, the pain persists or is uncontrollable, there are various surgical measures which can be used. The most common surgical procedure is microvascular decompression. This is a micro surgical procedure where the trigeminal nerve is identified within the skull and any irritating or compressing blood vessels are carefully dissected off the nerve and held away from it using a variety of measures.