Trigeminal neuralgia is characterized by intense and debilitating chronic pain affecting one side of the face. Currently, there are a number of treatment options to reduce pain: tricyclic antidepressants, anticonvulsants, psychotherapy, and surgeries called rhizotomy and microvascular decompression (MVD). Clinical Pain Advisor reports that, in an observational study, MVD was effective in relieving pain in both idiopathic and classical trigeminal neuralgia. In fact, according to the study, the pain relief can last for at least two years, if not more. 

Within this study, which was published in the Journal of Headache and Pain, researchers explored the efficacy of microvascular decompression surgery on trigeminal neuralgia pain relief. Altogether, 115 patients enrolled. The patients were then followed for a 24-month period after the surgery. Findings include:

• 70% (81 patients) reported being completely pain-free and not having to use any additional therapeutic interventions.
• 4% (5 patients) experienced no pain relief at all, and a small subset (2%, or 3 patients) experienced worsening pain. 
• 10% (12 patients) experienced no pain for around 12 months and then experienced some pain or required some medication within the next 12 months. 5% (6 patients) experienced a major pain recurrence after 12 months, which means that they either did not have pain relief or their pain worsened. 
• Men were more likely to respond to microvascular decompression surgery than women. Those with classic TN also had better outcomes than those with idiopathic TN. 
• Side effects and complications included permanent hearing loss, impaired coordination, cerebrospinal fluid (CSF) leak, cerebellar or brainstem infarction, and severe numbness. 
• 94% (108 patients) stated that they would recommend MVD surgery. Even 27 out of 33 patients who experienced severe complications would recommend this surgery. 

More research is needed to determine whether microvascular decompression could be an effective pain-relieving measure for longer than two years. For now, however, the study leaders share that microvascular decompression should be an option for people with trigeminal neuralgia for whom other treatments are not working.

What is Microvascular Decompression? 

Mayfield Brain & Spine, a clinic that specializes in neurological surgery, explains that microvascular decompression is:

a surgical procedure to relieve the symptoms (pain, muscle twitching) caused by compression of a nerve by an artery or vein. Surgery involves opening the skull (craniotomy) and exposing the nerve at the base of the brainstem to insert a tiny sponge between the compressing vessel and the nerve.

This sponge works by moving the nerve away from the blood vessel’s pressure and pulsing. Compared to a rhizotomy, MVD is believed to cause less facial numbness. 

An Overview of Trigeminal Neuralgia (TN) 

Also known as tic douloureux, trigeminal neuralgia is a neurological condition which causes chronic pain in the trigeminal (5th) cranial nerve. This condition may result from a blood vessel pressing on the nerve, tangled arteries, nerve injury, a tumor, or multiple sclerosis. There are two forms of trigeminal neuralgia: typical (TN1) and atypical (TN2). The former causes extreme, sudden burning or shock-like facial pain that can last for a few seconds or a few minutes. These attacks then continue for up to two hours. Alternately, TN2 is characterized by continuous burning or aching. While people may only have one form of TN, it is possible to have both forms. 

Trigeminal neuralgia is more common in females than males, and more common in people over 50. However, it can affect people of all ages. Painful episodes may be triggered by eating or drinking, touching your face, talking, smiling, or even strong gusts of wind. Symptoms can, but do not always, include:

• Intense electric-shock-like spasms in the lower face, jaw, and nose
• Numbness and tingling
• Dull, unilateral facial pain
• Excessive salivating
• Depression and anxiety