Typical case
Aunt Wang experienced discharge like pain in the left eye socket, forehead, infraorbital area, and above the corner of the mouth six months ago, which was intermittent and irregular. The pain was severe during the attack, and she was afraid to speak, wash her face, brush her teeth, and sometimes even eat, seriously affecting her life and mood. She had visited major hospitals in many places, considering trigeminal neuralgia, and had been taking medication for treatment. The current medication treatment effect was poor, and the pain and discomfort continued to recur, with poor dosage and obvious adverse reactions. In order to further diagnose and treat the condition, the patient sought treatment in the pain department of the hospital.
After a thorough understanding of the condition, a detailed treatment plan was developed - trigeminal nerve microsphere compression surgery. The patient agreed and was quickly admitted to the hospital. After completing relevant examinations and confirming that the patient had no contraindications for surgery, the minimally invasive surgery was performed under general anesthesia. The patient had no pain and recovered quickly after the surgery, and could be discharged the next day. After 6 months and 1 year of follow-up, the patients had no pain and did not need to take medication again. The postoperative effect was very good and the patients were very satisfied.
Disease Science Popularization
What is Trigeminal Neuralgia?
Trigeminal neuralgia is a brief and recurrent paroxysmal pain in the distribution area of the facial trigeminal nerve, which can be accompanied by muscle twitching, also known as painful twitching, and is the first pain in the world. Trigeminal neuralgia is divided into two types: primary and secondary. Secondary trigeminal neuralgia includes brain space occupying lesions and vascular compression. The etiology and pathogenesis of primary trigeminal neuralgia are still unclear in Western medicine. Most of them are over 40 years old, with middle-aged and elderly people being the majority. There are more women than men, about 3:2.
Trigeminal neuralgia often occurs without warning, while pain attacks are generally regular. Each pain attack lasts only a few seconds to a few minutes and suddenly stops. At the initial onset, the frequency of attacks is relatively low, and the interval is also long, ranging from minutes to hours. As the condition progresses, the attacks gradually become more frequent, the interval period gradually shortens, and the pain gradually worsens and becomes severe. Talking, eating, washing face, shaving, brushing teeth, and blowing in the wind can all trigger pain attacks. There are often trigger points, also known as "trigger points," which are often located on the upper lip, nose, gums, corners of the mouth, tongue, eyebrows, etc. Lightly touching or stimulating the trigger points can trigger pain attacks.
How to distinguish trigeminal neuralgia from toothache?
The pain site of trigeminal neuralgia is very limited, mostly on one side of the face, often mistaken for toothache. However, there are still differences between the two:
1. Different onset times: toothache does not occur during the day or at night, and it also hurts during the day and at night; Trigeminal neuralgia is usually painful during the day and not at night.
2. Pain range and duration: toothache belongs to local pain, and the pain duration is relatively long, with a stiff sensation. Trigeminal neuralgia involves a relatively large range, with pain lasting from a few seconds to a few minutes. The pain sensation is intermittent and presents a stinging sensation, and the pain is not limited to the upper and lower jaw areas.
3. Whether there are triggering factors: Trigeminal neuralgia is often induced by facial movements, such as speaking, washing face, brushing teeth, laughing, eating, yawning, sneezing, blowing cold air, etc. Severe toothache may have triggering factors, but it usually does not cause sudden pain.
4. Taking painkillers: Generally, painkillers can alleviate the pain in teeth; Taking general painkillers for trigeminal neuralgia has no effect. After taking painkillers, if the pain does not subside, it should be taken seriously.
So, if you experience toothache, don't rush to have your teeth extracted. First, check if your symptoms match the characteristics of trigeminal neuralgia.
How to treat trigeminal neuralgia?
In principle, drug therapy is the preferred treatment for primary trigeminal neuralgia. Surgical treatment may be considered for patients with poor drug efficacy or intolerance.
Medication therapy
Carbamazepine is the preferred choice, while sodium phenytoin, gabapentin, and pregabalin can also be used for the treatment of trigeminal neuralgia. However, drug therapy generally involves the possibility of resistance, with good initial efficacy, but as the disease progresses, symptom control often deteriorates.
Surgical treatment
1. Microvascular decompression
Microvascular decompression is a minimally invasive craniotomy method that pushes open the blood vessels that compress the trigeminal nerve under a surgical microscope, relieving the pressure on the trigeminal nerve and relieving clinical symptoms. Microvascular decompression is a minimally invasive surgery with excellent efficacy, good safety, low postoperative recurrence rate, and the ability to preserve nerve and vascular function. It is the preferred surgical method for treating trigeminal neuralgia.
2. Percutaneous trigeminal nerve balloon compression surgery
Percutaneous trigeminal nerve balloon compression surgery involves puncturing the trigeminal nerve meniscus under X-ray or CT guidance, applying balloon compression to damage the meniscus, and subsequently relieving trigeminal neuralgia.
This surgery does not require craniotomy, has a high pain relief rate, short hospitalization time, and fast postoperative recovery. Suitable for patients with poor pain tolerance, advanced age, poor physical condition, multiple underlying diseases, and unsuitable for long-term general anesthesia, it is one of the better minimally invasive surgical methods.
3. Gamma Knife Treatment
Gamma knife treatment uses a stereotactic method to focus gamma rays on the root of the trigeminal nerve, and by controlling the irradiation dose, blocks the patient's sensory conduction, achieving the effect of controlling pain. For patients with trigeminal neuralgia who are extremely old and physically unsuitable for general anesthesia, gamma knife treatment can still be used.