Trigeminal neuralgia (TN) is described as a sudden, short duration (seconds to minutes), severe, sharp, lancinating or electric shock like pain occurring in the face. The trigeminal nerve is divided into three divisions: V1- forehead and eye, V2- the cheek, and V3- the jaw. The lancinating pain of trigeminal neuralgia can occur in one or all of these areas. It can be bilateral in 5% of patients, but in such cases it usually begins on one side of the face. Pain can be triggered by laughing, chewing, teeth brushing, talking, wind on the face, or even touching the face. An MRI scan with and without contrast is essential to rule out the presence of a tumor, arteriovenous malformation, or multiple sclerosis all of which can cause trigeminal neuralgia in a small number of patients.

Trigeminal neuralgia is first treated medically with anticonvulsants such as Tegretol (carbamezapine) Dilantin (phenytoin), Neurontin (gabapentin) or other medications such as Baclofen (lioresal). In many cases trigeminal neuralgia patients are not helped by these medication, experience breakthrough pain, or suffer with undesirable side effects. In such cases we feel that microvascular decompression (MVD) offers the most enduring solution for trigeminal neuralgia by treating the cause of the problem while at the same time minimizing the chance for post operative numbness.

(A) Cranial nerve five; (B) arteries compressing cranial nerve five at brainstem; (C) cranial nerve five with arteries decompressed using Teflon felt.

Currently the Minimally Invasive endoNeurosurgery Center (MINC) sees over 500 patients every year for trigeminal neuralgia. From this group approximately 150 are considered good candidates for MVD and undergo surgery. This concentrated volume at UPMC allows us to be a world leader in the management of trigeminal neuralgia with a national and international experience. This experience also allows us to pursue significant research activity aimed towards advancing the field. This has fostered the use of endoscopic assisted surgery as well as the treatment of atypical pain and recurrences. Finally, the large volume of cases has resulted in a comprehensive approach to the management of trigeminal neuralgia ranging from Gamma Knife radiosurgery, percutaneous glycerol rhizotomy, and alternative surgical management schemes. Trigeminal neuralgia treatment is tailored to the individual patient to select the best option for each unique situation.

Surgical microscopic view of cranial nerve five obscured
by bony shelf.

Endoscopic view of cranial nerve five beneath a
large bony shelf.

Operating on cranial nerve five using endoscopic image.

Results

Over the last 25 years over 25,000 patients with trigeminal neuralgia have been treated at UPMC. Immediate complete relief is found in 82% of patients with an additional 16% obtaining significant partial relief needing occasional medication or low dose for control. One year following surgery 75% of trigeminal neuralgia patients continue to have complete pain relief while and additional 8% have partial relief. Major complications occur in fewer than 5% of cases.