Trigeminal neuralgia, caused by a short circuit in the trigeminal nerve, can cause extreme pain in the 2 million Americans diagnosed with it. Now, a new surgery is helping eliminate the pain and getting patients back to their normal lives.
Merelia compares the pain to ripping or stabbing your eye, "It's scary."
Spending two years searching for a diagnosis while off and on pains shot up her face, Merelia was finally diagnosed with trigeminal neuralgia.
Nearly 140,000 nerve fibers make up the trigeminal nerve, most sending normal messages to the brain like when something touches your face. However, many of those fibers only send pain messages.
Although each nerve is insulated, when that insulation is damaged, pain nerves can be activated.
"So all the sudden, they'll send a lot of messages, a burst of messages, and the brain will think there's something painful happening in the face," said doctor Robert Goodman, chairman of St. Luke's-Roosevelt Hospital's Department of Neurosurgery in New York.
That same thing was something Abe Gruenwald dealt with for seven years – receiving misdiagnosis after misdiagnosis.
"I was on a medical odyssey," said Gruenwald. "[The dentist] did three root canals, all unnecessary."
Gruenwald's medical mystery ended when he found Goodman, who through surgery, tries to cure trigeminal neuralgia through microvascular decompression surgery.
To the right of the nerve is the basilar artery, which pushes on the nerve causing the pain. Goodman makes a small opening in the bone behind the ear and is able to move the artery and blood vessels away from the nerve.
He then inserts a shredded Teflon felt and sponge material that prevents it from touching the nerve, giving it a somewhat cushion so it cannot press against it again.
After Merelia had the surgery, she, like 90 percent of other patients, woke up with no pain.
Although surgery is an option, the first line of treatment for trigeminal neuralgia is medication. Radiation can also be used to target the nerve to shrink it, although surgery is the only way to cure it.
Face Pain Phenomenon
Background: 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.
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*Joanne H. Nicholas
Director, Public Affairs
Continuum Health Partners