Trigeminal neuralgia

Trigeminal neuralgia is a terrifying pain in the face and the strongest pain that a person can experience! Patients describe it as a shock-like pain, a lightning stroke, tearing, twitch, dragging the glowing needles through the face. Suicide cases of the patients who couldn’t deal with this pain anymore have been described!

Pain is caused by damage to the trigeminal nerve and occurs in seizures that last for a few seconds to two minutes. No matter how the attacks are often, there are completely painless intervals between them. A pain strike can be caused by a slight touch of the face, by talking or chewing. Sometimes every movement and every touch cause pain, and patients avoid to talk and eat, they drink on the straw, avoiding mouth opening, do not wash their face, do not wash their teeth, do not shave, avoid the smallest movement (face of the mummy). In order to avoid eating, they lose weight in a short period of time.

The disease is initially manifested by the rotation of painful and painless periods. The painful period (the period in which pain attacks occur) lasts several months, and after that, the painless period spontaneously comes (there are no pain attacks). Over time, painful periods are getting longer, and painless periods shorter, so that all patients eventually reach a constant painful period. Attacks occur with varying degrees of frequency, from a few to a large number during the day. The frequency of trigeminal neuralgia is four patients per 100,000 inhabitants per year.

Small surgical interventions
These include blockades and ablative surgeries from the field of pain surgery. Trigeminal nerve or its branches are blocked or cut at different levels, ranging from the periphery (face) to the center (brainstem). As the intervention is done closer to the brainstem, the effect is better and more long-lasting, but interventions are technically more demanding. All ablative operations have a time-limited effect, from a few months to several years.

Skull base surgery
The posterior skull exploration is a neurosurgical surgery that is performed in general anesthesia, lasting up to two hours and involves the exploration (examination) of the trigeminal nerve in the last cranial hole, on the place where it originates from the brainstem. Exploration using an operating microscope is most commonly encountered on the vascular compression of the trigeminal nerve as the cause of primary trigeminal neuralgia. The anatomically close artery rests on trigeminal nerve and with the pressure on sensitive nervous tissue, triggers the pathogenic mechanism of neuralgia.

During this operation, the arteries move away from the trigeminal nerve and thus eliminate the cause of the pain. This is the most successful way of treating trigeminal neuralgia that allows complete, lifelong pain relief in about 80 percent of cases.


Word of doctor

PhD Milica Čelebić

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