Trigeminal Neuralgia

Trigeminal Neuralgia 2017-12-07T18:51:38+00:00

Trigeminal Neuralgia, also referred to as tic douloureux, is a disorder of the fifth cranial nerve, called the trigeminal nerve, that causes episodes of intense, stabbing, electric shock-like pain. This intense pain is distributed in the areas of the face where the branches of the nerve are distributed – lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. Trigeminal neuralgia is not fatal but it is universally considered to be one of the most painful afflictions known in medicine. Approximately 100,000 people live with trigeminal neuralgia, with over 15,000 new cases developing every year.

Trigeminal neuralgia typically affects patients in their 50’s. It is characterized by intense, stabbing pain on one side of the face which lasts a few seconds to a minute or two. The pain is frequently triggered by patients shaving, brushing their teeth, chewing gum, talking, yawning, or even being hit in the face with an outside breeze. Women are more frequently impacted by trigeminal neuralgia than men.

In order to accurately diagnose trigeminal neuralgia, and rule out other causes of facial pain, Dr. Bovis takes a thorough history and performs a physical examination. Various laboratory tests may also be ordered to rule out other causes of facial pain. In addition, Dr. Bovis may order an MRI scan with contract and/or an MR angiogram (MRA).

Newly diagnosed trigeminal neuralgia will typically be treated with medications, both topical as well as oral prescriptions. Approximately 70 to 80% of patients respond well to this first line of treatment. Unfortunately over time, some patients may become tolerant of the prescribed medications whereby they lose their effectiveness. In addition, some patients are unable to tolerate the side effects.

For patients whose pain does not sufficiently subside with medications, either initially or over time, and for those patients who are unable to live with the side effects of the medication, several other treatment options are available.

Dr. Bovis offers the following three surgical treatment options for stubborn cases of trigeminal neuralgia:

  1. Microvascular decompression surgery
  2. Gamma Knife radiosurgery
  3. Percutaneous stereotactic radiofrequency rhizotomy

He will thoroughly discuss the pros and cons of each option for each individual patient’s circumstances.

Microvascular decompression is an open surgery performed in the operating room. During the procedure, Dr. Bovis will utilize advanced electrophysiological monitoring. During the procedure, Dr. Bovis will alleviate the pressure being placed on the cranial nerve by a neighboring blood vessel and will position a small “Teflon pillow” between the nerve and the blood vessel to ensure long-term pain relief. The surgical procedure will take two to three hours in the operating room and patients typically stay in the hospital for two to three days. Long-term studies have been performed on microvascular decompression surgery for trigeminal neuralgia with excellent results. Ten-year follow-up suggests 70% of patients still experience excellent pain control. For young, healthy patients, microvascular decompression may be an appropriate choice for long-term relief from trigeminal neuralgia. Microvascular decompression surgery is the most durable and immediate treatment of trigeminal neuralgia and may allow patients to completely discontinue their medication usage.

Alternatively, Dr. Bovis also uses Gamma Knife stereotactic radiosurgery to treat patients with trigeminal neuralgia at the Illinois Gamma Knife Center at Alexian Brothers Medical Center. Gamma Knife radiosurgery, is a well-proven, non-invasive treatment for trigeminal neuralgia that has not responded to medical therapy. In many cases, Dr. Bovis will perform the Gamma Knife procedure for trigeminal neuralgia on an outpatient basis, so patients return home the same day. Many studies have looked at the long-term outcomes of the use of Gamma Knife radiosurgery to treat trigeminal neuralgia. These studies have shown long-term pain relief in over 70% of patients for several years. Should patients have a recurrence of pain, Gamma Knife radiosurgery may be used again to treat the condition. Dr. Bovis has significant experience treating patients with trigeminal neuralgia using Gamma Knife radiosurgery. In fact, he frequently presents his approach to treatment and results at the annual meeting of the American Association of Neurological Surgeons as well as at other medical conferences throughout the year.

Dr. Bovis performs surgery to treat trigeminal neuralgia at Advocate Lutheran General Hospital and Alexian Brothers Medical Center. He also welcomes questions about trigeminal neuralgia. Prospective patients are welcome to call (847) 698-1088 to schedule an appointment.