Trigeminal Neuralgia Surgery – Is It Your Best Option?

Trigeminal neuralgia (TN) is a severe neurological condition that causes sudden, intense facial pain, often triggered by simple activities like eating, speaking, or even a light touch. Flare-ups are unpredictable, causing debilitating, electric shock-like pain that severely impacts daily life and mental well-being.

For many, the chronic nature of this condition, along with the limitations it brings to normal activities, leads them to consider surgical options such as microvascular decompression or nerve ablation. While surgery may offer relief, it carries risks, including nerve damage, facial numbness, and recurrence of pain over time. 

Research indicates the success rate of surgical approaches like gamma knife radiosurgery (GKRS) is 70–90%. Because of this, it is critical to weigh other options against surgery when looking for the right approach to managing TN.

At the Centeno-Schultz Clinic, physicians in the licensed Regenexx network provide interventional orthobiologic approaches designed to support the body’s natural healing processes. Using image-guided orthobiologic injectates, these non-surgical options aim to address nerve-related dysfunction and inflammation, reducing the need for surgery.

When Is Surgery Usually Recommended For This Condition?

TN is a chronic pain condition that affects the trigeminal nerve. This is one of the largest cranial nerves, and it is responsible for facial sensation and motor functions such as chewing.

This nerve has three main branches: the ophthalmic, maxillary, and mandibular nerves, each covering different regions of the face. When affected by TN, even mild stimuli such as touch, chewing, or speaking can trigger sudden, severe pain.

TN arises from irregular activity in the trigeminal nerve. This can be due to damage, irritation, or nerve compression. Sometimes, the condition is idiopathic, meaning its exact cause remains unknown. Risk factors include:

• Compression of the trigeminal nerve: This can happen due to a nearby blood vessel that compresses or irritates the nerve. 
• Multiple sclerosis (MS): MS causes demyelination, the deterioration of the protective myelin sheath around nerves. This increases the risk of several neurological complications, including TN. Studies show that 15% of TN patients are later diagnosed with MS, while up to 3.4% of individuals with MS develop TN.
• Genetic factors: A 2021 study suggests that 1-2% of TN cases have inherited traits, though the exact link remains unclear.
• Brain lesions or strokes: Damage to the trigeminal nerve or related structures may lead to TN-like pain.
• Post-viral nerve damage: Research suggests a possible connection between TN and nerve damage from conditions like shingles.

TN is considered rare. 2023 research suggests that this condition may affect approximately 5.5 people per 100,000, with around 15,000 new cases registered annually in the U.S. Women over 50 are twice as likely as men to develop the condition.

Symptoms of TN include:

• Sudden, stabbing, or electric shock-like pain on one side of the face, with nearly 60% of cases occurring on the right side. Bilateral TN is rare.
• Episodes lasting from seconds to minutes, often recurring in clusters over days, weeks, or months.
• Burning or aching pain between attacks in some cases.
• Worsening pain intensity over time. As nerve damage progresses, attacks last longer.
• TN doesn’t self-resolve, and pain-free intervals (remission periods) shorten over time.

According to 2024 research, patients describe the intense pain of TN as worse than childbirth or a heart attack. Beyond physical pain, TN can significantly impact mental health. 

A 2018 study indicated TN was involved in 26% of suicide attempts among patients who had chronic headaches, while 2015 research suggests that individuals with TN are at greater risk of developing depression and suicidal thoughts. 

When medication and other conservative measures fail to provide relief, these factors lead many to opt for surgery as a solution.

Conventional Trigeminal Neuralgia Surgical Procedures

Surgical techniques aim to alleviate the pressure on the trigeminal nerve and alleviate the symptoms of TN. Common techniques include:

• Microvascular decompression (MVD): This surgical procedure aims to alleviate pressure caused by blood vessels on the trigeminal nerve. During MVD, a neurosurgeon accesses the nerve through a small incision behind the ear. 

A tiny Teflon pad is inserted using microsurgical techniques to cushion the nerve and protect it from pressure. 2023 research indicates that MVD has a success rate of 80% after 5 to 10 years. Complications include infection, hearing loss, or cerebrospinal fluid leaks. 

• Gamma knife radiosurgery (GKRS): GKRS utilizes targeted, high-dose radiation to ablate the root of the trigeminal nerve. This prevents the nerve from transmitting pain signals. This approach is less invasive than open surgery and may help reduce symptoms and flare-ups. Potential adverse effects include facial numbness or tingling. Additionally, pain relief may be gradual: the average time for pain relief after GKRS is 1.6 months.
• Balloon micro-compression: This technique involves guiding a small catheter through the cheek to the trigeminal nerve. Here, a balloon is inflated to compress the nerve. The compression disrupts the nerve’s ability to transmit pain signals, offering relief. Though effective, this approach can prevent the nerve from transmitting sensory signals, causing patients to experience temporary numbness.
• Rhizotomy/nerve ablation at the foramen ovale: This procedure selectively destroys part of the trigeminal nerve to block pain signal transmission. The trigeminal nerve is accessed through the foramen ovale, an opening at the base of the skull through which nerves pass. From here, surgeons may use heat, chemicals, or a mechanical technique to ablate the nerve fibers. Complications include ongoing facial numbness or altered sensation due to disrupting nerve pathways.

Why Surgery Is Not Always the Best Option for TN

Surgery for TN isn’t suitable for everyone. Though it offers potential relief, it comes with elevated costs, health risks, and prolonged recovery timelines. Additionally, not all patients are surgical candidates due to their overall health or the location and cause of nerve compression. 

Age, other medical conditions, and previous treatments also affect the decision. Sometimes, the potential benefits don’t outweigh the risks or drawbacks. Lastly, 2015 research indicates that 75% of TN cases can be managed with non-invasive methods, reducing the need for surgery.

High Cost of TN Surgery

The financial burden of TN surgery can be significant. 2018 research suggests that it costs patients suffering from recurring facial pain an average of US$3,000 per year due to prescription medicine, travel, and missed work days. 
However, surgical procedures like microvascular decompression can be as high as US$50,100. Insurance coverage can play a vital role, though it’s not always comprehensive. Patients often face high out-of-pocket expenses, including costs for hospital stays, anesthesia, and follow-up care.

Risks Associated with Surgical Interventions

Surgery for TN comes with inherent risks. Complications may include:

• Infection at the surgical site: This occurs when harmful bacteria enter the wound, potentially leading to redness, swelling, and discharge. Infections can delay healing and may require antibiotics or additional medical care.
• Bleeding or cerebrospinal fluid leaks: These complications stem from the delicate nature of surgery near the brain. Damaging blood vessels or the cerebrospinal fluid sac can lead to persistent headaches. Increased pressure inside the skull (intracranial pressure) can also occur, which can cause symptoms like severe headaches, nausea, vomiting, and vision changes, potentially leading to more serious neurological issues if not addressed.
• Anesthesia-related issues: Anesthesia can lead to problems such as nausea or allergic reactions. 
• Permanent nerve damage: Surgical manipulation around the trigeminal nerve can lead to permanent nerve damage. Complications include ongoing numbness or weak facial muscles.

It’s essential that patients discuss possible risks and outcomes and have realistic expectations. Understanding surgical risks is essential in making an informed choice.

Prolonged Recovery Time

Recovery time varies across TN surgeries. Procedures like microvascular decompression may involve several weeks of healing. Less invasive procedures like GKRS or balloon micro-compression offer reduced recovery periods. 

Factors affecting recovery include the patient’s overall health and adherence to post-operative care guidelines. A physician may recommend rest, limited physical activity, and attending follow-up appointments to minimize complications while promoting healing.

Life After Trigeminal Neuralgia Surgery

After successful surgery, you may experience some pain relief. However, surgery can necessitate lifestyle changes, and discussing expectations with a physician is important. 

For instance, you may need to modify your diet and physical activity to facilitate healing. Physicians may recommend avoiding sudden movements that can affect recovery. Regular follow-up appointments help monitor and manage potential long-term side effects, including permanent numbness and nerve damage.

Alternatives Beyond Surgery 

Non-invasive approaches can help manage TN without surgery. The Centeno-Schultz Clinic uses interventional orthobiologic treatments that aim to alleviate pain and support the body’s healing processes. These therapies target the root causes of discomfort and focus on restoring nerve function and reducing ongoing inflammation.

NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) help reduce inflammation and manage pain, including that caused by TN. These drugs, available over-the-counter and prescription, work by inhibiting enzymes contributing to inflammation. 

They may help ease symptoms during flare-ups. However, long-term use can cause side effects, including stomach ulcers, kidney disease, and an increased risk of heart attack and stroke. 

Physical Therapy

Physical therapy uses guided exercises to improve neuromuscular health. It uses various techniques, including manual manipulation, acupuncture, and massage therapy.

It may aid in several ways:

• Strengthens the muscles of the neck, face, and skull, offering better support to structures like the spine and nerves.
• Releases tension in affected areas, which eases pressure on the trigeminal nerve and, in turn, pain.
• Manipulation techniques boost blood flow, enhancing nutrient and oxygen delivery to tissues. This helps reduce inflammation and promote healing.
• Techniques like massage therapy can cause the release of chemicals like endorphins, which act as natural painkillers.

Additionally, 2021 research suggests that alternative therapies like meditation and mindfulness may help reduce the intensity and frequency of flare-ups. These therapies work by easing stress and encouraging relaxation.

Is There a Safer And More Effective Trigeminal Neuralgia Treatment?

Procedures using Regenexx lab processing to treat TN utilizes interventional orthobiologics to support the body’s natural healing process. The Regenexx approach offers patients a less invasive alternative that reduces the need for TN surgery or long-term use of prescription drugs.

PRP Treatment

Platelet-rich plasma (PRP) is a non-invasive approach that involves extracting a small amount of the patient’s own blood. This sample is then processed to concentrate the platelets, which are the blood cells responsible for healing and tissue regeneration. 

Once concentrated, the platelets are then injected back into the affected area. The platelet-rich plasma contains growth factors that promote healing and reduce inflammation.

PRP may benefit patients with TN because it provides: 

• Minimally invasive techniques: Minimally invasive techniques typically offer quicker recovery. By avoiding large incisions, these approaches reduce discomfort and the risk of complications.

• Targeted pain relief: Targeted approaches relieve pain by focusing directly on the trigeminal nerve. Unlike NSAIDs and other therapies that affect the whole body, this precision reduces systemic side effects, such as stomach ulcers. 

PRP therapy is non-invasive and tailored to individual needs. Compared to invasive or general approaches, it may offer benefits such as less pain, better nerve function, and quicker recovery. Many prefer PRP over surgery for its success rate, and it can be an attractive option for those seeking personalized treatment. Consider a consultation to see if PRP therapy fits your needs.

The IGNIte Procedure

The IGNIte (image-guided autologous neurobiologic injections) procedure uses the patient’s own blood, which contains healing agents and growth factors. The autologous neurobiologic injections are guided by precision imaging, such as ultrasound. This approach reduces risks and supports the body’s natural healing abilities. 

This approach may be a valid option for those looking to create the conditions for the trigeminal nerve to heal itself. Consider scheduling a consultation to determine whether this approach is right for you.

Choose the Right Treatment for Trigeminal Neuralgia

The Regenexx approach provides a non-surgical path to recovery for those experiencing TN pain. It also reduces the need for prescription medications such as opioids and steroids. These procedures offer an alternative to traditional surgical approaches, helping individuals improve mobility and quality of life with less downtime. 

Find out whether the Regenexx approach is right for you by contacting a physician within the licensed Regenexx network at the Centeno-Schultz Clinic.