SYMPTOMS
Essential or idiopathic trigeminal neuralgia is a painful affliction triggered by the demyelination of more or less extensive parts of the trigeminal nerve branches, the fifth pair of cranial nerves. The symptomatic condition is caused by oral infections, most frequently from the teeth.
Trigeminal neuralgia usually manifests itself with attacks of pain that affect a more or less extensive parts of the face. The attacks, sudden and short-lived, always very painful, at the start are wide apart, characteristically intermittent. Between one attack and the other there are periods of complete well-being; and suddenly, without apparent cause (or as a result of stimuli such as speaking, swallowing, sneezing, etc.), there is pain, blinding pain. As the months go by, the attacks become more frequent, until they are several times a day. This situation ends up causing a deep state of tension, fear and anxiety, caused by the fear that an attack may suddenly be triggered.
The painful phenomenon is blinding, initially localized at one point of the face and then, very rapidly, it radiates to the whole area pertaining to the trigeminal branch concerned; the length of time of this is extremely short: it is a real electric shock, painful, protracted for a few seconds. After the painful attack, phenomena similar to a vasomotor disorder and, in addition, increased nasal secretions and tears can be observed. However, many therapeutic options are available to effectively treat trigeminal neuralgia. A Trigeminal Neuralgia specialist is able to study appropriate treatment for the patient’s medical case.
The inconclusive pharmacological therapy for trigeminal neuralgia is based on the use of antiepileptic drugs, often with serious side effects (vertigo, nausea, heartburn, leukopenia, hives, etc.). The efficient treatment for trigeminal neuralgia, considering that a cure does not exist, surely is the surgical one.
SURGICAL OPTIONS MOST USED TODAY ARE:
Percutaneous micro-compression of Gasser’s ganglion: mechanical compression, to a sedated patient, of Gasser’s ganglion by a Fogarty balloon catheter. It has a good chance of success but the duration of the benefit does not exceed 6-8 months.
Microsurgical neurovascular decompression: It is a highly invasive surgical technique that requires an occipital craniotomy to reach a supposed cerebellar artery loop at the base of the skull, up to 14-17 cm. This type of surgery is rarely successful and risks further, more serious complications.
Radiofrequency of Gasser’s ganglion: a needle enters the Gasser’s ganglion and sends a radio frequency current by means of a generator, at a temperature which can cause a thermal injury in the ganglion. It can give a good result knowing how to measure the temperature, duration, and location; otherwise, pain, insensibility and incurable burns may result.
This mininvasive therapy, practiced at the Medical Studio of Prof. Ugo Delfino, is performed on sedated patients with targeted fluoroscopy. Particular radiological imaging make it simple to visualize the foramen ovale at the base of the skull and reach the small Gasserian ganglion. The chemical lesion, by ethanol, creates a minimum and restricted damage which lasts 6/10 years, and which does not touch any part of the brain. This kind of action damages the thin pain-sensory nerve, saving the other more resistant nervous structures. In this way, the sensitivity of the face is preserved. This technique, different from all the others, has been widely tested since 1978 and it can be practiced at all ages in complete safety.
N.B. no cuts, no stitches
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