Trigeminal neuralgia (tic doloreaux) is a rare disorder of the fifth cranial (trigeminal) nerve manifest by sharp, shooting electrical-type pains usually on one side of the face. It is triggered by minor stimuli, often chewing, talking or feeling cold wind on the face. Trigeminal neuralgia is almost always caused by a small blood vessel pushing against the trigeminal nerve. Hemifacial spasm entails the involvement of the seventh cranial nerve (facial nerve) with involuntary spasms of part or all of one side of the face.
This disorder is manifested by constant twitching of the muscles of the face. These symptoms are often progressive and interfere with simple activities in addition to becoming socially unacceptable. In severe cases, the spasms can cause problems with vision on the affected side because the surrounding eye muscles spasm the eyelid shut.
The first line of treatment is always medical with antiseizure medication (tegretol or dilantin). Should medical treatment fail, a number of surgical treatments are available. These can be either (1) open surgery consisting of craniotomy with microvascular decompression of the trigeminal or facial nerves (MVD) or (2) percutaneous techniques for the fifth nerve, which involves either radio frequency rhizotomy, balloon compression or glycerol injections. The latter techniques are usually used in older patients who are at a higher risk of open brain surgery. Occasionally, Gamma Knife radiosurgery is utilized in this disorder.
The success rate of all of these procedures is usually 75% to 95% although recurrent cases may be more difficult to treat longterm. The surgeons of Dallas Neurosurgical & Spine are experienced in all of these techniques and tailor surgical treatment to the individual patient.
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