Frederick Law Olmsted (1822 -1903) was a United States landscape architect, famous for designing many well-known urban parks, including Central Park in New York City. He was also known to have suffered intensely from Trigeminal neuralgia most of his life. Before the turn of the century, there was no relief. But thankfully today, new treatments offer patients relief and a better quality of life. Of course, this information is by no means exhaustive or all-inclusive, and you are encouraged to discuss any specific concerns or questions with a qualified surgeon.
What is Trigeminal Neuralgia?
Also known as TN or Tic Douloureux, Trigeminal Neuralgia is a debilitating disorder of the Trigeminal nerve, the fifth of the 12 cranial nerves. This nerve provides sensation to the face, teeth, mouth and nose. Different people with TN may experience stabbing, unbearable pain in different parts of the face. Some patients are misdiagnosed as having a toothache and end up having unnecessary root canal or tooth extraction. Even an act as ordinary as chewing food or brushing teeth can trigger intense and insufferable facial pain.
How is Trigeminal Neuralgia Diagnosed?
Diagnosing Trigeminal Neuralgia is difficult because there are no definitive diagnostic tests. Physicians typically diagnose TN based upon the patient's description of the facial pain and tests that rule out other causes of facial pain, such as TMJ, shingles, multiple sclerosis or tumors. This is where experience in diagnosing TN is important. Finding a doctor who has the experience is key to both a proper diagnosis as well as the right approach to relieving TN.
What to look for in a Center for TN Treatment
In looking for a clinic, hospital or center for best treatment of Trigeminal Neuralgia, here's what you need to look for:
o Physician experience. Since TN is not a definitive diagnosis and often requires more than one medical treatment approach, it's best to seek a neurosurgeon who is very familiar with TN and has extensive experience in treating the condition.
o A center that provides a multi- modality approach. You do not want to be jetting from one hospital or clinic to the next in search of an answer or to get different treatments. There are places that offer the benefit of a complete treatment plan, integrating all treatment options, that can be implemented and overseen, in one place. TN is stressful enough without having to book hotels and make arrangements for different cities and states.
o Up-to-date technology and approaches. This includes a Gamma Knife, the newest tool in the fight against TN. Ironically, there is no surgical knife involved with Gamma Knife treatment.
Patients are treated for Trigeminal neuralgia using all available treatment options or a combination, including the newest tool, the Gamma Knife. Patients may have one or a combination of the following proven treatments:
o Medication- The first line of treatment for TN is generally medication. Anticonvulsants are frequently used and are effective for many patients but must be tailored to the patient's medical condition, age and general medical status. This includes kidney and liver function since many of these medications may have effects with long-term use on kidney and liver function if they are not closely monitored.
o Surgery- Trigeminal Glycerol Rhizolysis (TGR- TN) – This is a same-day procedure. After being sedated, patients are placed on the operating table and a special x-ray device is used to help the neurosurgeon insert the needle through your mouth. The needle is advanced until it reaches a small pocket of fluid surrounding the Trigeminal nerve. Injecting the right amount of Glycerol is crucial. And you will have had enough of the "cocktail" sedation to the point you could care less if the nurses start dancing on your belly with golf spikes (they never do this, by the way).
o Surgery- Microvascular Decompression (MVD-TN ) – Considered the most invasive form of surgical treatment for Trigeminal Neuralgia, it is also the procedure with the highest success rate. Since this is an invasive procedure, it is reserved for patients who are in generally good health without major medical problems and patients must have general anesthesia. Basically, it's a procedure whereby a neurosurgeon makes an incision through the back of the ear, goes through the skull and elevates a blood vessel off of the Trigeminal nerve and places a synthetic barrier between the nerve and the vessel so that it no longer pulsates on the brain stem.
o Non-Invasive Surgery- Gamma Knife Treatment- The Gamma Knife (GK) is not really a knife or surgery at all but a non-invasive, outpatient procedure that focuses extremely precise cobalt radiation beams on the target area. It is the high tech of technology. Individual beams are too weak to damage healthy tissue, but very powerful when they simultaneously merge at a single focal point. Most patients have brain surgery with the GK and go home in time that day for dinner. It is a very effective and non-invasive treatment for TN. Basically, it works by changing the nerve path that conducts the pain.
This is simply an overview of what is available for getting treatment and relief from the debilitating pain of Trigeminal Neuralgia. The good news is that one or a combination of these treatments works to relieve the condition for most people. Sometimes the treatment does not last forever and patients need to go back for more treatment years later, but typically when this is the case, it is successful the next round as well.
If you or someone you know wants more information in patient-speak, I've provided a link below to a guide for people suffering from TN with more detail than I have provided here. No one should think they have to suffer from this unbearable facial pain. There is relief.