Trigeminal Neuralgia: Surgical Treatment
If medication is not effective or produces undesirable side effects, neurosurgical procedures are available at OHSU and recommended by Dr. K. Burchiel to treat facial pain. The goal of surgical treatment of facial pain is to eliminate the pain without creating or adding to symptoms. To achieve that goal all of the following are taken into consideration:
- patients' age
- medical condition
- symptoms
- underlying primary cause
- experience of the neurosurgeon
- patients' preference
Steps taken before embarking upon a surgical procedure
A detailed description of medical symptoms is obtained, along with a detailed medical history. An accurate diagnosis is made characterising the facial pain (see facial pain classification scheme). The primary cause or origin of the facial pain is determined. Initial treatments are undertaken followed by medical treatment. In the event that medical treatment is unsuccessful then a decision to undergo a surgical procedure is made. Finally based on all previous diagnostic factors, a surgical procedure is recommended.
- Symptoms
- Diagnosis
- Primary Etiology
- Initial Treatment
- Surgical Decision
- Surgical Procedure
Neurosurgical procedures
Procedures vary from relatively minor nerve blocks/injections and surgery through the cheek (percutaneous), to open skull surgery and targeted radiation. Each procedure has certain advantages and disadvantages - ease of the procedure, effectiveness, long-term results, recurrences, and complications. Among the existing neurosurgical treatments for facial pain, none is uniformly successful and free of complications.
Surgical choice will depend on a number of factors, including age, medical condition, symptoms, underlying primary cause, experience of the neurosurgeon, and patients' preference. Some surgeries are outpatient or one-day procedures, while others require hospitalization.
Surgical options for facial pain presently offered by Neurological Surgery at OHSU include:
- Microvascular decompression
- Radiofrequency rhizotomy
- Glycerol rhizotomy
- Stereotactic radiosurgery
- Trigeminal stimulation
- Motor cortex stimulation
