Trigeminal Neuralgia: Causes, Diagnosis and Treatment Options

Absolute contraindications include cardiac problems, any bleeding or coagulation disorders, or severe infection in the body. If a patient — for example with trigeminal neuralgia — is responding well to medication at a controllable dose, we will not operate; surgery is offered when the patient's pain is not relieved despite medical management.

There can be anaesthesia-related complications. On the surgical side, we can get a haematoma in the cerebellum, sometimes bleeding, sometimes infection, or damage to the nerves — though our infection rate is very low. One patient developed chemical meningitis leading to hydrocephalus and needed a shunt, but the rest did very well. Initially some patients complained of partial hearing loss from traction on the eighth nerve; now we use minimal traction, so results are good and complications are minimal.

Only about 5%, not more than that. In our setup we have done more than 100 surgeries and have not had to redo any; some patients may have mild symptoms that can be managed with medicine or reassurance, but otherwise the results are good.

We do endoscopic third ventriculostomy in paediatric congenital hydrocephalus, but success is slightly lower at a young age — around 70-80%. A programmable shunt has a 95% success rate, but shunt revision and infection are other factors to weigh; endoscopic third ventriculostomy is a better choice when it succeeds, since the chances of recurrence problems afterward are very low.

We keep the patient for three or four days; the pain is usually gone right after surgery. We continue medication for one month afterward and then stop it. We mobilise the patient to walk from the next day, and they generally do very well. We do a post-operative CT scan to check for any bleeding or collection, but results are close to perfect.

Severe pain in specific facial areas corresponding to the branches of the trigeminal nerve, near the eyelid, below the eye, or elsewhere, and in rare cases the tongue, often triggered by shaving, brushing teeth, eating, drinking or even cold air.

In most cases a blood vessel, often a vein or artery, forms a loop that compresses the trigeminal nerve and causes demyelination, though tumours and other compression can also be responsible.

Diagnosis starts clinically, based on the pattern and triggers of the pain, and is confirmed with a good-quality MRI using CISS sequences, which can show the vascular loops that are often the underlying cause.

Radiofrequency ablation and glycerol injections relieve numbness in 50 to 20 percent of cases but pain often returns within six months to a year, and gamma knife radiosurgery takes a long time to work and only partially relieves pain, which is why microvascular decompression has become the preferred option.