Center for Facial Pain

Treatments for Trigeminal Neuralgia

Medication

The first treatment considered for TN is medication, most often anticonvulsants such as carbamazepine.  Dilantin, and most recently Carbatrol and Trileptal, are other possibilities.

As the disease progresses, sufferers may find that medications cannot control the worsening pain. If the spasms become intolerable or if side effects from increased dosage of painkillers are a problem, surgical or radiotherapy treatment may be recommended.

Microvascular Decompression

Neurosurgeons perform a microvascular decompression through a small incision behind the ear. The surgeon uses a microscope to assess the trigeminal nerve as it arises from the brain stem. Then he attempts to alleviate neurovascular compression upon the nerve root by using micro-instruments to move the blood vessels that are irritating the trigeminal nerve. This allows the nerve to recover and the patient to return to a normal, pain free condition. Recovery from this procedure is brief. Most patients can be discharged from the hospital one or two days after surgery.

Glycerol Rhizotomy

Percutaneous glycerol rhizotomy is a minimally invasive alternative treatment for trigeminal neuralgia.  It consists of a drop or two of glycerol injected through the patient's cheek around the trigeminal nerve at the skull base using a spinal needle.  This operation is performed under local anesthesia with sedation in the operating room and is done as outpatient surgery.

Novalis Stereotactic Radiosurgery

Novalis stereotactic radiosurgery is a promising treatment for trigeminal neuralgia. Beams of radiation directed at the trigeminal nerve root cause a lesion to form over a period of time, interrupting the pain transmission. For some patients, this procedure can reduce the pain of TN within a few weeks. About 80% of patients treated thus far with Novalis have enjoyed a significant (greater than 75%) or complete reduction of pain within 4 to 8 weeks of treatment.

In selected situations, Novalis technology can subsequently be utilized for a “re-treatment” of the trigeminal nerve root, with special modifications of dose and technique to spare critical structures.

• More about Novalis radiosurgery
• “Novalis Team Cures Intense Facial Pain”

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Center for Facial Pain
Donner Pavilion
2001 Medical Parkway
Annapolis, MD 21401

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• Facial Pain Home
• What is Trigeminal Neuralgia?
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