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Trigeminal Neuralgia – Surgical Options

January 27, 2022


There are two main categories of surgical interventions that get done for trigeminal neuralgia type 1. The one that people mostly read about or hear about is a procedure called microvascular decompression. That involves a craniotomy and a craniotomy is making an actual opening in the skull. An opening is made in the skull. The surgeon then actually inspects the nerve with the use of a microscope. Typically what’s found there is a blood vessel resting on the nerve itself. The neurosurgeon will then place a piece of teflon or some other inert material between the nerve and the blood vessel and the result of that (in most cases) is that the patient then wakes up free of their trigeminal neuralgia pain and in a majority of patients, they are cured of their affliction for years, decades to come. The other category of surgical intervention is where we are actually putting a needle through the cheek, up into the nerve, and then in some fashion making a controlled injury to the nerve. Some surgeons make that controlled injury with heat. Some surgeons use a balloon. Some surgeons use another type of liquid, which will actually injure the nerve in a very controlled way. That’s the other kind of intervention that gets done. The advantage of that is that you don’t have to have a craniotomy. The disadvantage is that the cure rate is far, far less – perhaps more on the order of 50% treatment rates at 2-3 years, rather than surgery, which offers a 70% treatment or cure rate at 10 years.

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