Trigeminal Neuralgia / Tic Douloureux
Trigeminal neuralgia, also known as tic douloureux,
is a fairly uncommon cause of facial pain. The term
trigeminal refers to the fifth cranial nerve, which
is called the trigeminal nerve. This nerve transmits
sensation from the forehead and face. There is one on
each side of the head. Trigeminal neuralgia nearly always
involves a single nerve. Trigeminal neuralgia is more
common in women than in men and is rare in patients
under fifty years of age.
Cause of Trigeminal Neuralgia / Tic Douloureux
There are a number of possible causes of trigeminal
neuralgia including pressure on the trigeminal nerve
by a small artery or vein or a tumor in the back portion
of the brain. Multiple sclerosis can also be a cause
of these same symptoms.
Trigeminal Neuralgia / Tic Douloureux Symptoms
The classic symptom of trigeminal neuralgia is sudden,
sharp, severe pain occurring in the forehead, cheek,
jaw or a combination of these locations. The pain typically
lasts only a few seconds and may repeat frequently.
The pain is often described as an electric shock. The
pain may be triggered by touching a certain spot on
the face, eating, talking or swallowing. The symptoms
may come and go.
Trigeminal Neuralgia / Tic Douloureux Diagnosis
As always, a careful history and physical examination
are the first steps in diagnosis. In fact, in most cases,
the diagnosis is made by history and examination alone.
The examination should be normal. If there is a suspicion
of tumor or multiple sclerosis, an MRI scan of the brain
should be obtained.
Trigeminal Neuralgia / Tic Douloureux Treatment
The main treatment for trigeminal neuralgia is medication.
There are a number of medications that may be tried
either alone or in combination. These include phenytoin,
baclofen, carbamazepine and neurontin. If medication
fails to relieve the pain then surgical treatment may
be proposed.
Surgical treatment for trigeminal neuralgia falls into
three categories. The first is called percutaneous rhizotomy.
This involves an operation performed under light anesthesia
during which a probe is placed into the region of the
trigeminal nerve. The nerve is then treated with one
of the following; radiofrequency (heating), injection
of glycerol or pressure from a small balloon. All of
these methods have been shown to be effective in treating
trigeminal neuralgia.
A second surgical treatment for trigeminal neuralgia
is microvascular decompression. This involves an operation
in which a small opening is made in the skull and the
trigeminal nerve is inspected for the presence of an
artery or vein causing pressure. The offending blood
vessel is carefully moved away from the nerve and a
pad is placed to protect the nerve from further compression.
Finally, stereotactic radiosurgery (highly focused
radiation) using the Gamma Knife is a surgical option
for the treatment of trigeminal neuralgia. This is a
procedure that allows a very high dose of radiation
to be delivered to the trigeminal nerve without damage
to the surrounding structures.
The particular type of surgical treatment proposed
depends on the individual patient.
Call 1-800-411-CINN or the location nearest
you between 8 AM and 5:30 PM Central Time, Monday through
Friday to schedule an initial consultation with a CINN
physician.
|
