Mount Sinai physicians usually prescribe anticonvulsant drugs and other medications to control the symptoms of trigeminal neuralgia. Because the pain often worsens over time, medication that controlled your pain initially may gradually become less effective.

If your medication is unsuccessful in relieving your symptoms or causes undesirable side effects, such as nausea, dizziness, confusion, or severe drowsiness, your doctor may recommend surgery. Several surgical interventions are available to treat trigeminal neuralgia, both ablative (destructive) and non-ablative (non-destructive) procedures.

Ablative procedures

Ablative procedures are designed to injure or partially destroy the trigeminal nerve, thereby lessening the transmission of pain impulses. These procedures are minimally invasive in that they use radiation, chemicals, electricity, or compression to ablate the nerve.

Because these procedures damage the trigeminal nerve fibers, some degree of facial numbness usually occurs as a result of ablative treatment. However, this is usually well-tolerated by the patient. Ablative procedures are generally associated with a higher recurrence rate than microvascular decompression.

Non-ablative procedures

Non-ablative procedures spare nerve function by addressing the primary cause of trigeminal neuralgia, vascular compression. Microvascular decompression (MVD), performed under general anesthesia, is a non-ablative technique that leaves the trigeminal nerve intact. In microvascular decompression, a small opening is made in the back of your skull on the side with the pain. The trigeminal nerve is viewed with a microscope and the compressing blood vessels are moved. The cause of pain is addressed by carefully displacing the compressing artery or vein away from the nerve and protecting the nerve with a soft pad (typically shredded Teflon) or sponge to prevent recurrence.

In appropriately selected patients MVD is highly effective with a very low complication rate of the procedure and a low recurrence rate for pain.

Mount Sinai's Joshua B. Bederson, MD, Professor and Chair of the Department of Neurosurgery, and Raj K. Shrivastava, MD, Assistant Professor of Neurosurgery, have excellent success rates using MVD on carefully selected patients. Experience has shown that prognosis after MVD is best in patients who meet the following criteria:

  • Your pain is on one side of the face only.
  • You experienced an initial response to anticonvulsant medical therapy.
  • Your pain follows the pathway of the trigeminal nerve.
  • Your pain is episodic rather than constant.

Even if your profile does not exactly match the above, you may still have an excellent response to microvascular decompression, depending on the findings.

We can help

If you have been diagnosed with trigeminal neuralgia or are experiencing symptoms, please call The Mount Sinai Health System at 212-241-2377 to schedule an appointment.

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