What is trigeminal neuralgia surgical procedure?
Trigeminal neuralgia surgical procedure is a process to decompress the trigeminal nerve that will trigger ache and discomfort within the face.
Trigeminal neuralgia surgical procedure is a therapy for facial nerve ache (neuralgia) that’s brought on by irritation within the trigeminal nerve. The trigeminal nerve has three primary branches on both sides of the face, which mix as a bundle of nerves (Gasserian ganglion). Trigeminal neuralgia surgical procedure is carried out to remove the irritation within the nerve when drugs should not efficient.
Surgical therapy for trigeminal neuralgia is of three varieties:
- Microvascular decompression
- Percutaneous procedures
- Gamma knife surgical procedure
Microvascular decompression (MVD) process
MVD is an open surgical procedure carried out by a neurosurgeon with the affected person beneath normal anesthesia.
The affected person could also be required to
- Undergo blood exams.
- Undergo magnetic resonance imaging (MRI) and/or magnetic resonance angiogram (MRA) of the mind to guage blood vessel malformation or blood vessel impingement on the trigeminal nerve.
- Avoid consuming and ingesting for eight hours previous to the process.
- Check with the physician earlier than taking any common treatment.
- Inform the physician of any allergy symptoms.
- Attaches an IV line and administers normal anesthesia.
- The anesthesiologist screens the affected person’s very important indicators through the process.
- Makes an incision within the pores and skin behind the ear.
- Makes a 3-cm opening within the cranium (craniotomy).
- Opens and retracts the mind’s membrane (dura) to entry the trigeminal nerve.
- Moves the blood vessel and releases the trapped trigeminal nerve.
- Places a Teflon sponge between the nerve and the blood vessel.
- May additionally reduce or destroy part of the trigeminal neve.
- Closes the dura with sutures and applies a surgical glue to forestall leakage of cerebrospinal fluid (CSF).
- May exchange the bone piece utilizing surgical glue or use a titanium plate to shut the outlet within the bone.
- Closes the incision with sutures.
- The affected person’s very important indicators are monitored within the restoration room.
- The affected person is weaned off the anesthesia and administered painkillers.
Percutaneous trigeminal neuralgia procedures
Percutaneous procedures are normally carried out by ache administration specialists as an outpatient process, utilizing native anesthesia and gentle sedation or temporary normal anesthesia.
- The affected person undergoes blood exams and MRI.
- The physician inserts a needle lateral to the nook of the mouth into the Gasserian ganglion, with the steerage of steady X-ray (fluoroscopy).
- The physician might carry out one of many following:
- Pass an electrical present via the needle and produce a thermal lesion with the warmth, disrupting the ache indicators (Percutaneous radiofrequency trigeminal gangliolysis [PRTG] or radiofrequency rhizotomy).
- Insert a balloon and inflate it for as much as 10 minutes to wreck the Gasserian ganglion and block the ache indicators (Percutaneous balloon decompression [PBM]).
- Inject glycerol to destroy the nerve’s ache fibers (Percutaneous retrogasserian glycerol rhizotomy [PRGR]).
- The physician withdraws the needle and applies a bandage.
- The affected person can depart for residence the identical day.
Gamma knife surgical procedure for trigeminal neuralgia
- Radiation therapists carry out the Gamma Knife remedy as an outpatient process.
- A body is mounted to the pinnacle with 4 pins to maintain the pinnacle motionless.
- An area anesthetic is used on the pin web site.
- The radiologist makes use of stereotactic MRI for concentrating on the exact location of the trigeminal nerve the place it connects to the mind stem.
- The radiologist makes use of the Gamma Knife system to ship managed beams of radiation on the purpose the place the trigeminal nerve connects to the mind stem, to dam the transmission of ache indicators.
What is the restoration time for trigeminal neuralgia surgical procedure?
A microvascular decompression might require as much as 4 days of hospitalization. Most folks return to regular actions in about three weeks however might need to keep away from strenuous actions for some time longer.
Most folks can resume regular actions inside two days after percutaneous procedures or a Gamma Knife surgical procedure.
What are the dangers and issues of trigeminal neuralgia surgical procedure?
Lack of aid and recurrence of neuralgia are the first dangers with all trigeminal neuralgia remedies. Other issues embody:
- Abnormal facial sensation (facial dysesthesia)
- Facial numbness
- New facial ache
- Loss of sensation within the cornea (corneal anesthesia)
- Weakness in jaw muscle groups (masseter weak point)
Microvascular decompression has further dangers that embody:
- Anesthetic negative effects resembling
- Surgical dangers resembling
- Blood clots
- Wound an infection
- Injury to mind stem
- Injury to part of the mind (cerebellum)
- Cerebrospinal fluid leakage
- Pain in an space that’s fully numb to the contact (anesthesia dolorosa)
Medically Reviewed on 5/14/2020
Medscape Medical Reference