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Finding a Neurosurgical Trigeminal Neuralgia Specialist

Home » Finding a Neurosurgical Trigeminal Neuralgia Specialist

If you have facial pain, you may be suffering from trigeminal neuralgia. Trigeminal neuralgia is a facial pain condition that occurs spontaneously and is characterized by sharp, shock-like pain involving one side of the face. Other potential symptoms may include ear pain, teeth pain, hypersensitive face, or a numbing/burning sensation of one side of the face.

Not all maladies that affect the trigeminal nerve are considered trigeminal neuralgia. Often it proves difficult for the physician and patient to determine the fine differences between trigeminal neuralgia and other forms of neuropathic face pain. In order to decide on the proper treatment plan it is imperative to recognize these differences. Finding a facial pain neurosurgical specialist is important for establishing the correct diagnosis and beginning proper treatment.

Multiple treatment options exist for trigeminal neuralgia, and what may be the right treatment for one person, may not be the best treatment for you. Selecting a neurosurgeon that specializes in trigeminal neuralgia management is essential for receiving the best possible care for your condition. This article provides information and discusses a guideline for finding the right neurosurgeon to help treat your trigeminal neuralgia.

Getting Started: Understanding your condition and options

The incidence of newly diagnosed cases of TN in the United States population averages approximately 4.3 per 100,000 individuals (per year) according to the Facial Pain Association. Despite the rarity of trigeminal neuralgia, many neurosurgeons offer various treatment options for this condition, which can make finding the best possible care difficult. Let’s look at the overall treatment process for trigeminal neuralgia in order to better understand how to navigate finding the best practitioner for you.

Once you are diagnosed with trigeminal neuralgia by your primary care provider or neurologist, the first-line treatment option for your facial pain involves medications aimed at relieving your neurogenic pain. These medications are often managed by a neurologist or primary care provider. At times, patients with chronic facial pain may develop drug resistance or intolerance to these medications. In cases, where medication treatment fails to provide adequate relief of the facial pain, additional treatment options are warranted, and this is where a neurosurgeon will become needed in your care. These additional neurosurgical treatment options include:

  • Microvascular decompression, an open surgery that separates blood vessels that are compressing the trigeminal nerve away from the nerve
  • Trigeminal rhizotomy, a procedure where the trigeminal nerve fibers are selectively damaged to help reduce or completely alleviate facial pain
  • Stereotactic radiosurgery, a procedure where focused radiation beams target a specific site along the trigeminal nerve where it exits the brainstem helping to relieve facial pain

What option is best for me?

With multiple treatment options available for trigeminal neuralgia, it can be hard to determine what intervention is best for your condition. Understanding the cause of your trigeminal neuralgia is important to guiding the selection of a treatment option. Trigeminal neuralgia may be caused by a variety of conditions, including:

  • Blood vessel compression against the trigeminal nerve
  • Breakdown of the myelin insulation causing exposure of the nerve fibers of the trigeminal nerve
  • Brain mass (i.e tumor, cysts)
  • Stroke
  • Demyelinating disease (i.e. Multiple sclerosis)
  • Or in some cases the reason may be unknown

Brain imaging studies help to best identify which of the above causes is most likely causing the facial pain. The most helpful imaging study, is an MRI of the brain focused on evaluating the trigeminal nerve and nearby vessels. Thin-slice, muti-planar steady-state free precession (SSFP), T2-weighted sequences are best for obtaining detailed understandings of the trigeminal nerve’s condition. These scans are also referred to as constructive interference steady state (CISS), or fast imaging employing steady-state acquisition (FIESTA) sequences. Other MRI sequences, such as the T1-weighted with contrast, can also help rule out tumors that may be causing symptoms.

Although there are exceptions to the rule, vessel compression on the trigeminal nerve causing facial pain, is often best treated with a microvascular decompression, whereas, no vessel compression with trigeminal neuralgia symptoms may be best treated with a trigeminal rhizotomy or radiosurgery depending on a patient’s medical condition, goals, and exceptions with treatment.

Finding the right neurosurgeon:

With so many treatment options available for trigeminal neuralgia, it is important to find a neurosurgeon who is knowledgeable and experienced with all of these techniques in order to offer the best care for your particular situation. Reaching out and meeting with various neurosurgeons can be helpful for evaluating qualities that may help relieve your facial pain. Although some surgeons may be able to do this via phone or email, consider asking for an in-person appointment. Knowing the neurosurgeon’s education and training can be a helpful comparison amongst practitioners in the profession. Have a list of questions prepared to ask the neurosurgeon, and evaluate how your doctor answers your inquiries. Your doctor should listen to your symptoms and situation and provide clear explanations on treatment options. Although trigeminal neuralgia is a complex condition with intricate treatment options, your doctor should be able to clearly communicate your surgical options as well as the risks and benefits. Some questions to consider include:

  • Does the surgeon have experience treating facial pain conditions?
    • Understanding the patient condition with trigeminal neuralgia is an important aspect when finding a neurosurgeon for this condition. Determine if your doctor has an area of specialization in trigeminal neuralgia.
  • What treatment procedures does the surgeon provide (i.e. microvascular decompression, trigeminal rhizotomy, radiosurgery)? What are the associated risks and benefits?
    • A microvascular decompression is not always the best treatment option for trigeminal neuralgia. It is important to have a neurosurgeon who can assess your condition and offer alternative treatment options, if needed.
  • Is the surgeon a member of a facial pain organization? Is he up to date on the literature about trigeminal neuralgia?
    • Staying up to date on or contributing to trigeminal neuralgia research and studies can be a good gauge on a surgeon’s level of involvement with trigeminal neuralgia care.

Ultimately, whomever you decide to choose should instill a sense of trust in you. Consider how comfortable you felt with your doctor and the office staff following your initial meeting. How do they compare to your standards and expectations? Some questions you should ask yourself after meeting your neurosurgeon include:

  • Was the doctor easy to talk to?
  • Did the neurosurgeon thoroughly answer all of my questions in a clear manner?
  • Did the neurosurgeon appear knowledgeable about trigeminal neuralgia and the treatment options?
  • Do I understand why the proposed treatment option is best for me?

Building a good relationship with your neurosurgeon can take time, and being able to communicate your concerns and understand treatment plans are important aspects in your treatment process. In the end, working with your surgeon with open communication will provide the best chance for effectively treating your condition and returning to a normal lifestyle without facial pain.

  • Key Points
    • If medication is not treating your facial pain, discuss options with your neurologist or primary healthcare provider:
      • It is important to remember that the first line treatment for trigeminal neuralgia is neuropathic pain medications. Even if you are looking for surgical treatment options, it will be important to keep your neurologist/PCP in the loop as you choose a neurosurgeon and proceed with surgical intervention as some of the neuropathic pain medications need to be slowly tapered off over time if the surgical procedures prove to be effective.
    • Learn more about your neurosurgeon
      • Gather information about your neurosurgeon’s education, training, and experience with treating patients with trigeminal neuralgia. Determine whether the surgeon, or practice, is able to provide all intervention options (microvascular decompression, trigeminal rhizotomy, and radiosurgery), as different patients may respond better to one treatment option versus another.
    • Evaluate your neurosurgeon at the first visit
      • Understand your treatment options, outcomes, risks, and benefits
      • Open communication with your neurosurgeon will provide you with the best chance for effective treatment.

Contributer: Chikezie Eseonu, MD – Clinical Assistant Professor of Neurosurgery at University of Pittsburgh Medical Center Pinnacle