trigeminal neuralgia scope

Written by Chen Yu Fei
Neurosurgery
Updated on August 31, 2024
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The range of trigeminal neuralgia attacks is usually located in the sensory area of the trigeminal nerve root, broadly covering both sides of the patient's nostrils and around the corners of the mouth. The nature of the pain is quite severe, often described as knife-like pain or burning pain. The duration of each pain episode varies, often starting and stopping suddenly. Around the pain area, fixed trigger points are likely to form. Accidentally touching these trigger points while brushing teeth, washing faces, or rinsing mouths can often trigger an attack of trigeminal neuralgia. Over time, due to repeatedly triggering the pain by touching these points, patients may become afraid to wash their faces or brush their teeth, and may experience facial muscle numbness or atrophy.

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Written by Shu Zhi Qiang
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How is trigeminal neuralgia diagnosed?

Trigeminal neuralgia is divided into primary and secondary types. Primary trigeminal neuralgia refers to cases where no specific cause is apparent. However, with the advancement of modern medicine, doctors have discovered that there is actually a cause for primary trigeminal neuralgia. It is due to the lack of protective myelin sheath over the initial segment of the trigeminal nerve, which gets irritated by the pulsation of nearby small arteries. In such cases, further investigations like brain MRI and cerebral angiography can usually identify the responsible blood vessel. On the other hand, secondary trigeminal neuralgia occurs along with corresponding tumors and inflammation during the progression of the neuralgia, and MRI can assist in diagnosis.

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Can trigeminal neuralgia be cured completely?

Trigeminal neuralgia manifests as stubborn, intractable pain, but that does not mean we are helpless against it. The treatment of trigeminal neuralgia mainly involves the following aspects. Medication can only relieve symptoms and is not a cure. Radiofrequency ablation can destroy the trigeminal ganglion, but there is also a high probability of recurrence. The principle of Gamma Knife is somewhat similar to radiofrequency ablation, and the possibility of recurrence is also relatively high. Currently, the most effective treatment for a complete cure is surgical treatment, with about 80%-90% of patients with trigeminal neuralgia achieving complete eradication through treatments such as microvascular decompression surgery.

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Trigeminal neuralgia symptoms

Regarding the symptoms of trigeminal neuralgia, there is a very typical symptom, which is the issue of trigger points. A trigger point is a specific spot on the face, which varies for each person. Once this spot is touched, it immediately triggers the pain of trigeminal neuralgia. The nature of trigeminal neuralgia pain is often like cutting or stabbing pain, and the duration varies. If the condition is mild, the initial attack may only last a few seconds, but if the condition gradually worsens without significant improvement, the pain can even last for several minutes. This pain significantly impacts patients, sometimes triggering pain during activities such as brushing teeth, rinsing the mouth, or chewing hard food. Early treatment is essential to mitigate this pain.

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Is trigeminal neuralgia easy to treat?

Whether trigeminal neuralgia is easy to treat must be judged based on the situation at the time. The vast majority of patients with trigeminal nerve pain can find a corresponding cause, such as compression by blood vessels, tumors, or infection factors. For vascular compression, microvascular decompression surgery can be adopted for treatment. For tumor compression, craniotomy and tumor resection can be adopted for treatment. For some infectious factors, treatment such as anti-infection and hormones can be adopted. These are relatively easier to treat, and most can have a very obvious prognosis. However, there are also cases, such as trigeminal neuralgia where no specific cause has been found, called primary trigeminal neuralgia, where active complete treatment is not possible, and only certain methods can be used to alleviate the general symptoms of the patient and reduce their suffering.

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Trigeminal neuralgia should register for which department?

The department for registering trigeminal neuralgia depends on the distribution of departments in the local hospital. Most commonly, registration is done in the department of functional neurosurgery. However, different hospitals may have different levels of specialization and may employ varying treatment methods which require different departments. For instance, initially, one can register at the department of neurosurgery for oral medication adjustment, usually with carbamazepine. If there is no significant improvement later on, one may register with the department of pain management or anesthesiology for nerve block treatment. Due to the detailed specialization in some hospitals, it might also be necessary to consult other departments. If there is still no effective outcome, it is necessary to register at the department of neurosurgery for surgical treatment to fundamentally address the disease.