Acıbadem International Hospital Brain and Nerve Surgery Specialist Prof. Dr. Sabri Aydın gave information about trigeminal neuralgia, also known as 'sudden facial pain', and its treatment.
Neurosurgery Specialist Prof. Dr. Sabri Aydın listed the characteristics of pain in trigeminal neuralgia, the symptoms of which vary from patient to patient:
“It comes in attacks.
It occurs in the form of lightning flashes and electric shocks, lasts for 1-2 minutes and passes suddenly.
It occurs on the chin, nose, cheek or eye. In some cases, it can cover the entire face.
It can occur when there is no stimulus, but it can also be triggered by cold-hot food, eating, brushing teeth, opening the mouth, talking and cold air.
The trigeminal nerve originates from the brainstem and controls sensations particularly in the temple, forehead, and chin. The task of this nerve is to transmit the senses of touch to the brain and to move the jaw muscles. Therefore, the pain caused by the problems developing in the trigeminal nerve is felt on the face, forehead, temple and chin area. Toothache is one of the most common complaints in trigeminal neuralgia. Neurosurgery Specialist Prof. Dr. Sabri Aydın said, “Especially mandibular nerve pain that feeds the jaw can be misdiagnosed because it is very confused with toothache. Or, patients may have to have their healthy teeth extracted to get rid of their pain. For this reason, most of the patients have gone to the dentist and come to us with many healthy teeth extracted.”
Stating that trigeminal neuralgia, which is diagnosed in an average of 3 people every year in our country, is seen 200 times more in women than in men, Prof. Dr. Sabri Aydın said, “The reason for this is that the lower and posterior parts of the brain, called the posterior pit of women, are anatomically narrower. The exact cause of trigeminal neuralgia is unknown. It is generally seen at the age of 2-50 years, suggesting that the disease is not congenital or genetically transmitted. In many patients, the cause of the problem is the contact between the trigeminal nerve, located at the base of the brain, and a normal blood vessel. This contact puts pressure on the trigeminal nerve and causes it to send false signals over time. In addition, tumors developing in that area, adhesions due to previous infections, plaques caused by Multiple Sclerosis and some dental treatments can also cause trigeminal neuralgia.” used his statements.
prof. Dr. Sabri Aydın said, “Treatment of trigeminal neuralgia usually starts with drugs that reduce or completely prevent pain signals sent to the brain. In some of the patients, the pain goes away with medication and does not recur. However, although there is a very good response to the treatment, over time, the drugs may stop responding positively or serious side effects such as liver damage may develop. Treatments aimed at relieving pain are another method. In this treatment, blocks are made to the nerve roots in the face, but the effect is usually short-lived.” he said.
Surgical treatment comes to the fore in patients who no longer respond to drug treatment, cannot use drugs due to side effects, and whose daily ergonomics and psychology are impaired due to pain. Neurosurgery Specialist Prof. Dr. Sabri Aydın stated that there are 3 options in the surgical treatment of trigeminal neuralgia and summarized these methods as follows:
“Trigeminal RF”
The Trigeminal Radiofrequency Rhizotomy method, in which the nerve is burned by entering the head with an injection from the face area, is completed in about 15 minutes. The patient returns home the same day as the pain is gone. Pain usually recurs within 1-2 years and the procedure can be repeated.
“MVD (Microvascular Decompression)”
It is considered one of the most effective surgical procedures for trigeminal neuralgia. This method, which is performed in the form of open surgery, aims to remove the pressure of the artery that causes trigeminal neuralgia on the facial sensory nerve. In the operation performed under microscopic imaging, a small incision behind the ear is entered into the head, and the trigeminal nerve and its close neighbor vessel are detected. In order to relieve the pressure of the trigeminal nerve, a buffer is placed between the vessel and the nerve. Complaints do not recur in 90 percent of patients after the operation.
“Gamma knife”
Gamma knife, which is a single-session treatment method, is based on the destruction of the part of the nerve in the brain stem with radiation. The positive effect of the method begins after a few months. It is stated that the Gamma knife method is a good option especially for the elderly and Multiple Sclerosis patients.
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