​Trigeminal Neuralgia and Atypical Trigeminal Neuralgia

Diagnosing Trigeminal Neuralgia and Atypical Trigeminal Neuralgia

Symptoms of trigeminal neuralgia

Your doctor may ask about any symptoms you are experiencing.

Symptoms of trigeminal neuralgia often include:

• Severe, stabbing facial pain. The sensation may be dull or sharp and appears suddenly.
• Spontaneous pain triggered by activities that involve touching or moving the face.
• Episodes of facial pain that span from several seconds to several minutes.
• Pain focused on one spot or side of the face at a time. In rare conditions, trigeminal neuralgia may affect both sides of the face.
• Episodes of pain that become more intense and frequent over time.

Testing to diagnose trigeminal neuralgia

MRI scans with and without an injected contrast dye are essential to diagnosis because similar symptoms can occur due to:

• A tumor
• Arteriovenous malformation
• Multiple sclerosis

Trigeminal Neuralgia and Atypical Trigeminal Neuralgia Treatments

Medication

Trigeminal neuralgia is first treated with anticonvulsant drugs, and doctors may prescribe other medications as well. In many cases, patients are:

• Not helped by these medications
• Experience breakthrough pain
• Suffer undesirable side effects

In such cases, UPMC surgeons usually recommend one of the following treatments:

• Microvascular decompression
• Gamma Knife® radiosurgery
• Percutaneous glycerol rhizotomy

Microvascular decompression

Microvascular decompression is a minimally invasive surgical procedure using endoscopes that:

• Treats the cause of the problem
• Offers the most long-lasting relief
• Minimizes risk of postoperative side effects like numbness.

Microvascular decompression relieves abnormal compression of a cranial nerve. The surgery consists of a linear incision behind the ear followed by a craniectomy (bony opening) the size of a silver dollar.

Under the view of a microscope or endoscope, the surgeons detect the area where the blood vessel is affecting the nerve and then separate them, leaving a Teflon "pillow" in between.

Each year, more than 500 people with trigeminal neuralgia are treated at UPMC, including about 100 who undergo microvascular decompression.

This high volume allows doctors here to pursue research aimed at improving treatment effectiveness, making UPMC a world leader in the management of trigeminal neuralgia.

In the last 25 years, UPMC neurosurgeons have treated more than 20,000 patients with trigeminal neuralgia. Treatment provides:

• Immediate, complete relief in 82 percent of cases 
• 16 percent achieve partial relief and require occasional or low-dose medication

One year after surgery:

• 75 percent of our patients continue to enjoy complete pain relief
• 8 percent have partial relief

Major complications occur in fewer than 5 percent of cases.

Gamma Knife® radiosurgery

Gamma Knife radiosurgery is a painless procedure that uses hundreds of highly focused radiation beams to target tumors and lesions within the brain, with no surgical incision.

Patients with typical trigeminal neuralgia who have had an adequate trial of medications can be offered Gamma Knife treatment. It is typically used for

• People with medical co-morbidities or pain that continues after surgical procedures
• People at risk for side effects from percutaneous ablative procedures
• People in more advanced age groups.

UPMC is the nation’s leading provider of Gamma Knife procedures. Over its 25-year history at UPMC, Gamma Knife stereotactic radiosurgery has proved effective for nearly 12,000 patients with:

• Benign or malignant brain tumors
• Vascular malformations
• Pain and other functional problems