Trigeminal Neuralgia Surgery

Trigeminal neuralgia is a condition characterized by severe facial pain resulting from the involvement of the trigeminal nerve (the 5th cranial nerve). This disorder typically manifests as sudden, knife-like pain attacks triggered by simple stimuli such as eating, speaking, or touching. Surgical methods can provide an effective solution for patients who do not respond to medical treatments. This article discusses the main techniques used in trigeminal neuralgia surgery.

Indications for Surgical Treatment

The first line of treatment for trigeminal neuralgia is usually medication. Anticonvulsant drugs such as carbamazepine and gabapentin are commonly used for this condition. However, in cases of drug-resistant patients or when medications cannot be used due to severe side effects, surgical treatment is considered. Surgical intervention may also be preferred based on the patient’s age, overall health condition, and the degree of impairment in quality of life.

Main Techniques Used in Trigeminal Neuralgia Surgery

1. Microvascular Decompression (MVD)

   Microvascular decompression is one of the most effective and long-term solutions for trigeminal neuralgia surgery. In this procedure, the surgeon relocates the blood vessels causing pressure on the trigeminal nerve and places a tampon (usually a Teflon pad) to protect the nerve.

   Advantages:
   Can offer a permanent solution.
   • High likelihood of completely relieving the pain.

   Disadvantages:
   • Requires brain surgery and is therefore more invasive.
   • Risk of complications such as infection, bleeding, or nerve damage.

2. Radiofrequency Thermal Rhizotomy

   In this method, a fine needle is inserted into the sensory root of the trigeminal nerve, and controlled damage is created in the nerve using an electric current. The goal is to deactivate the nerve fibers transmitting pain.

   Advantages:
   Minimally invasive.
   • The procedure is relatively quick, and recovery is fast.

   Disadvantages:
   • There is a risk of recurrence of pain.
   • Side effects such as facial numbness may occur.

3. Gamma Knife Radiosurgery

   Gamma Knife uses multiple beams of focused radiation to create controlled damage in the trigeminal nerve. This method is performed without the need for any incisions.

   Advantages:
   A non-invasive option.
   • Allows the patient to return to normal activities more quickly.

   Disadvantages:
   • Pain relief may take weeks or months to achieve.
   • In some patients, the full therapeutic effect may not be obtained.

4. Balloon Compression

   Balloon compression aims to deactivate the pain-conducting fibers by mechanically compressing the trigeminal ganglion. During the procedure, a fine balloon catheter is placed into the trigeminal nerve and inflated in a controlled manner.

   Advantages:
   A minimally invasive method.
   • Provides a rapid recovery time.

   Disadvantages:
   • Side effects such as temporary facial numbness may occur.
   • Risk of recurrence.

In trigeminal neuralgia surgery, the appropriate method should be selected based on the patient’s individual condition, the severity of symptoms, and previous treatments attempted. While microvascular decompression provides a long-term solution, minimally invasive methods may be preferred due to their lower risk profile. Each surgical option’s advantages and disadvantages should be carefully considered, and the decision should be made in collaboration with the patient. Trigeminal neuralgia surgery can be an effective treatment option that significantly improves the quality of life.