Carbamazepine is one of the most commonly used, first-line medical treatments for trigeminal neuralgia.  This medication is in the “anti-convulsant” family of medications and must be prescribed and adjusted under the guidance of an experience trigeminal neuralgia provider.  Carbamazepine can be very effective, especially at the early stages of trigeminal neuralgia.

Oxcarbazepine is also commonly used as a first- or second-line medication for facial pain.  Some people experience fewer side effects from oxcarbazepine and you should consider trying this medication if carbamazepine is failing you.

Baclofen is a muscle relaxant.  Some doctors will add baclofen to another more traditional medication to treat or relieve facial pain.

Microvascular decompression or “MVD” is a surgical procedure designed to create a buffer between the cranial nerve that’s “in trouble” and the blood vessel that is pushing on the nerve.  MVD surgery is performed under general anesthesia.  Patients are fully asleep during surgery.  During an MVD, space is created by placing teflon sponges between the cranial nerve and the blood vessel.  For trigeminal neuralgia, sponges are placed in between the SCA and the trigeminal nerve using an operative microscope [movie or illustration here].

MVD surgery is performed by an experienced neurosurgical team including a brain surgeon, neuro-anesthesiologist, surgical “scrub” technicians, operating room nurses and an experienced neurophysiologist.  Throughout the surgical procedure, patients are kept safe by using special monitoring equipment to ensure that functions of the brain and brainstem are protected throughout the surgical procedure. Critical cranial nerves for facial movement, hearing, and swallowing are “in play”, so an experienced team is critical to preventing hearing loss, facial numbness, or other potential side effects.  MVD surgery can be extremely safe and beneficial to patients.  Long term, most successful MVD patients remain pain free and off medications.

Gamma Knife Radiosurgery (GKRS) is not traditional surgery.  Rather, Gamma Knife Radiosurgery is a minimally invasive outpatient procedure designed to treat painful nerve disorders like trigeminal neuralgia without a knife.  In the case of trigeminal neuralgia, a small “shot” of radiation is placed on the trigeminal nerve where the offending blood vessel is touching the nerve.  In many cases, this location is on the trigeminal nerve just before it plugs into the brainstem.  GKRS is painless and general anesthesia is not required.  Patients leave the Gamma Knife facility on the same day of treatment, often before lunch, and have very few restrictions after the procedure is complete.

Percutaneous rhizotomy is a procedure designed to treat facial pain by targeting specific branches of the trigeminal nerve.  To perform a percutaneous rhizotomy for trigeminal neuralgia, a needle is passed through the inside of the mouth into the base of the skull using real-time images to guide the needle.  Once the needle is next to one of the branches of the trigeminal nerve, the branch is intentionally damaged using either heat (aka, radiofrequency rhizotomy), a chemical (aka, glycerol rhizotomy) or a balloon (aka, balloon compression rhizotomy).