Diagnosing Trigeminal Neuralgia
Trigeminal neuralgia diagnosis is based largely on history and physical exam. A patient with new idiopathic TN, or TN with no known cause, will actually have normal neurologic exam results and will not demonstrate any neurologic deficit of the trigeminal nerve or adjacent cranial nerves. Subsequent tests may be ordered to look for the cause of the problem, including blood tests, MRI of the head, and trigeminal reflex testing.
Treating Trigeminal Neuralgia
Trigeminal neuralgia can sometimes be successfully treated with certain medicines, which can include anti-seizure drugs, muscle relaxants and antidepressants meant to target the inflamed nerve.
Sometimes patients need surgery to relieve pressure on the nerve. The surgical techniques used include:
- cutting or destroying part of the trigeminal nerve
- destroying the nerve with a needle or probe placed through the skin using radiofrequency ablation, or an injection of glycerol
- electrostimulation
- balloon microcompression done through the skin
- removal of the tumor, if present
- stereotactic radiosurgery (Gamma Knife™)
- removal of a blood vessel that is putting pressure on the trigeminal nerve, called microvascular decompression, which appears to result in the longest lasting pain relief
Microvascular decompression is now being performed with endovascular techniques, with incision areas the size of a quarter, not several centimeters in length as with previous approaches.