Choosing a Surgical Procedure That is Best for You

Make sure of your diagnosis. 

Talk with your physician about classic trigeminal neuralgia versus neuropathic facial pain, or deafferentation pain. Many of the treatments for classic trigeminal neuralgia are not effective for other types of facial pain and could even make the pain worse. 

Educate yourself

Search reliable web sites for additional information

Read Striking Back!

Read all available medical literature

Recuperation

Willingness to have a major operation

General health and ability to tolerate surgical stress

A MVD is major surgery and requires opening the skull to get to the trigeminal nerve as it exits the brainstem.  On the other hand, an MVD actually protects the nerve by removing blood vessels that are compressing it. 

Other procedures are deliberately destructive: balloon compression, glycerol injection, radiofrequency lesioning, and radiosurgery. All of these cause some damage to the nerve in order to disrupt pain signals.

Branch of the nerve affected

If the pain is in the first division there is a slight risk that the destructive procedures will leave the cornea of your eye with no sensation.  The MVD has the highest rate in terms of preserving sensation in the cornea.  For destructive procedures, some physicians recommend the balloon compression.

Facial numbness?

The destructive procedures can cause numbness.  Most people can tolerate it and it’s far preferable to the pain of TN.  However, some patients have found it extremely difficult.

Toleration of recurrence

TN is more likely to recur with some procedures  than others. 

The MVD, which is slightly riskier because it’s major surgery, has the lowest rate of recurrence.

Accepting the risk

Can you accept the particular risks of the procedure you’re considering? Do you know what the risks are? People are very different in the way they deal with risks; therefore, this needs to be a personal decision, not a medical one.

Willingness to travel

Some of the procedures are only offered in certain areas of the country.

The more experienced physicians may not be in your area.

Many physicians only offer one or two procedures.

If the pain returns, do you have a local physician willing to manage the TN?

The decision

Ask all of these questions, get complete answers, talk to people who have had the procedures, and get all the other information you can. With your physician, you can make a good decision about which procedure will be best for you.