TRIGEMINAL NEURALGIA

Medications are usually the first option for treating trigeminal neuralgia, and some people may not need any other treatment. However, some people may become resistant to medications over time, or they may have unwanted side effects. For those people, other options include injections or surgery to treat trigeminal neuralgia. If the pain is caused by something else, such as multiple sclerosis, the doctor will address the root cause of that condition.

Medicines for trigeminal neuralgia - 

The following medicines are useful for trigeminal Neuralgia 
Anticonvulsants: Carbamazepine is the first-line treatment for trigeminal neuralgia, and it has proven to be effective for this condition. 
Other Anticonvulsant drugs: oxcarbazepine ,  lamotrigine, valproate and phenytoin .Some other drugs, like clonazepam, topiramate, pregabalin and gabapentin may also help.
Anticonvulsants may cause side effects such as dizziness, confusion, drowsiness and nausea. Carbamazepine may also cause a serious drug reaction in some people.
Antispasmodic agents: Patients can use muscle-relaxing agents such as baclofen by themselves or together with carbamazepine. These agents may cause side effects such as confusion, nausea and drowsiness. 
The drugs should be taken under Medical Supervision only. 

Pain Interventions for Trigeminal Neuralgia -  

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When patients exhibit intense, paroxysmal unilateral facial pain suggestive of trigeminal neuralgia based on their medical history, a comprehensive clinical examination is advised. To eliminate other potential disorders and identify any aberrant vessels, an MRI scan of the brain is recommended. Initial management typically involves medical intervention with appropriate medications. If medical treatments prove ineffective or if patients experience intolerable adverse effects, interventional or surgical approaches may be considered. In younger patients, Microvascular Decompression (MVD) is often the preferred treatment, while older patients may find Percutaneous Radiofrequency Lesioning around the Gasserian Ganglion to be the treatment of choice.

Radiofrequency thermal lessening (Percutaneous Radiofrequency (RF) Rhizolysis)- It is a procedure that aims to destroy the nerve fibres that cause pain. The patient will be given sedation or local anaesthesia. A Radiofrequency needle is inserted by the doctor through the face. The Gasserian Ganglion is reached by the needle.  A mild electric current is sent by the electrode to the tip to find out the exact nerve to be treated. Then RF Lessoning is done.. More lesions are made by the physician if required. This procedure may cause some temporary numbness in face which resolves over time. This is the treatment of choice for trigeminal neuralgia in the aged and can also be done in young individuals. The pain relief period is much longer compared to other techniques. This procedure may be done as a care procedure.

Gasserian Ganglion glycerol injection (Percutaneous Glycerol Rhizolysis)

This is the simplest technique in which 50- 90 % glycerol is injected at the trigeminal ganglion. The average duration of pain relief is 6 months to 1 year. The procedure can be repeated. Foraminal Fibrosis may occur by repeated injection. It aims to stop pain signals from the trigeminal nerve, which is responsible for sensation in the face. The trigeminal nerve has three branches that split from a main root and a ganglion, which is a cluster of nerve cells. The ganglion and the root are surrounded by a small pouch of spinal fluid called the trigeminal cistern. To perform the procedure, insert a needle through the face and into a hole at the base of the skull. Then, the doctor will guide the needle into the trigeminal cistern and inject a small amount of sterile glycerol. The glycerol will damage the trigeminal nerve and prevent it from sending pain signals. This procedure can often reduce pain, but it may not work for everyone. Some people may have pain again later, and some may feel numbness or tingling in their face.

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Gasserian Ganglion balloon compression  - It is a procedure that aims to stop pain signals from the trigeminal nerve, which is responsible for sensation in the face. The trigeminal nerve has a main root and a ganglion, which is a cluster of nerve cells. To perform the procedure, a hollow needle is inserted through the face and into the foramen ovale. Then, a thin, flexible tube (catheter) with a balloon on the end is pushed through the needle. The balloon is inflated by the doctor to put enough pressure on the trigeminal nerve and damage it. This prevents it from sending pain signals. In this technique, 4 Fr Fogarty catheter is inserted through 14G, 10 cm needle. The balloon is kept inflated there for 60 seconds to 120 seconds to selectively block A delta and c fibres. Pain relief period is 2- 74 months in different studies,

 

 

Other interventional treatment options forf trigeminal neuralgia

 

 

Stereotactic Radiation Therapy (Gamma knife) - Stereotactic Radiation Therapy stands out as a non-invasive approach for treating trigeminal neuralgia. Pain relief is not instantaneous, typically manifesting around three months after onset. Complete pain relief is achieved in approximately one-third of patients. While the procedure is deemed safe, there is a scarcity of extensive studies on its efficacy.

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Trigeminal Ganglion Cryotherapy - User A comparatively newer mode of neurolysis, Showing good results in trigeminal neuralgia.

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An emerging neurolysis method exhibiting promising outcomes in the treatment of trigeminal neuralgia is Gassarian Ganglion Stimulation, currently considered experimental. When conventional modalities prove ineffective, Trigeminal Ganglion Stimulation may be explored as an alternative approach.

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Surgical Microvascular Decompression

Microvascular Decompression involves a surgical procedure where the ganglion is isolated from the aberrant vessel using a sponge after performing a craniotomy.