Trigeminal neuralgia is an extremely painful inflammation of the trigeminal nerve that causes severe facial pain and spasm of the facial muscles on the compromised side. These painful attacks can occur after lightly touching the skin areas of the face along this cranial nerve. Specific medication could be very effective in reducing the frequency of attacks but surgery may be required.
When is the intervention indicated?
Surgery is reserved for those cases rejecting pharmacological treatment or when the medication’s side effects are considerable. The choice of one type of surgical procedure or another will depend on several factors such as age, type of pain, or underlying disease.
What is the operation about?
There are several types of surgical interventions to treat trigeminal neuralgia. The most effective and final technique is called microdecompression of the trigeminal nerve. This operation is performed under general anaesthesia. First, a bone window (craniotomy) is opened behind the ear, then the brain covers (meninges) are opened too in order to reach the trigeminal nerve, where a blood vessel (artery) is usually found – this is what is compressing the nerve and causing pain. The nerve it is separated at the point of contact with the artery, with and a "pillow" is placed to soothe nerve irritation and, consequently, pain. This type of surgery is usually not performed in patients of very advanced age.
The other type of technique used is nerve compression at its exit from the base of the skull, via a special needle that is inserted through the skin lateral to the mouth and, by means of X-ray monitoring, the so-called Gasserian (trigeminal) ganglion is reached – where the nerve starts. Once that spot is located, a small balloon is inflated and the nerve is compressed, resulting in the cessation of pain outbursts. This operation is performed under general anaesthesia and is indicated in elderly patients or those with more, different conditions.
Postoperative period – Trigeminal Neuralgia
In the event that the surgical intervention is vascular microdecompression of the trigeminal nerve, the usual postoperative period would be as follows: After the intervention you will be admitted to an Intensive Care Unit for at least 24 hours. Although the appearance of complications is very infrequent, this operation may entail very serious vital risks, so it is advisable that the first hours you are under strict monitoring.
After the first 24 hours in the ICU, if there are no complications, you will be admitted to an inpatient ward. The next day you will begin to sit up in bed and initiate oral tolerance. On the first days there may be a feeling of dizziness or instability, which will recede in the next few days. Between 24-48h after, if you tolerate it, you will start to try walking, initially accompanied and then independently. Hospital discharge is usually approved after 3-6 days, depending on your case and recovery rate.
You should try to think that you will continue the period of hospitalisation at home for at least one more week. Take the medication exactly as prescribed by your surgeon. Your medication for trigeminal neuralgia should remain the same until one month after surgery. If pain is reduced, your doctor will progressively decrease the prescription of painkillers.
The surgical wound should be kept clean and dry. You can shower, with assistance if needed, and then dry the wound well with a sterile pad or gauze, brush it with povidone-iodine (PVP-I, Betadine) and finally cover it with a sterile dressing. The stitches should be removed some seven days after surgery.
During the first week you should alternate periods where you sit, walk around your house and rest in bed. Do not leave home until sutures are removed. From the second week, walk every day for brief periods of time (15 minutes) while progressively increasing the distance. After 4 weeks you should go to Outpatients unit for a review.