Does Trigeminal Neuralgia Require Brain Surgery for Treatment?

When you’re in the grips of a neurological condition like trigeminal neuralgia, which has been described as some of the worst pain a human can experience, pain relief is a sought-after priority.

Though medications are always the first stop in pain management, if these fail to do the job, brain surgery might present the best opportunity for finding long-lasting relief from trigeminal neuralgia.

As leading experts in neurosurgery, Dr. Ali H. Mesiwala and our team have a significant amount of experience helping patients to overcome neurological conditions of all kinds, including the relatively rare trigeminal neuralgia — its lifetime prevalence is only between 0.16% and 0.3%.

So, if you’re in the small group of trigeminal neuralgia sufferers and you’re frustrated with treatment efforts to date, read on to explore whether neurosurgery might provide the relief you so desperately want.

First line of defense against trigeminal neuralgia

When patients come to us with facial pain and we make a trigeminal neuralgia diagnosis, our first line of defense for managing the pain is medication. 

This type of neurological pain, which stems from your fifth cranial nerve — your trigeminal nerve — typically doesn’t respond to traditional pain medications. From over-the-counter medications to opioid-based drugs, these medications often fail to provide relief.

Instead, we often rely on anticonvulsant medications, Botox®, and muscle relaxers, which can be effective. 

When medications for trigeminal neuralgia don’t work

Although many people with trigeminal neuralgia can successfully manage their trigeminal neuralgia with medications, this first line of defense doesn’t always do the trick.

Sometimes, these medications can start to fail after using them for a while, and people have to increase their doses. As well, some patients don’t like the side effects of the medications, which include brain fog and fatigue, so increasing dosages isn’t necessarily a great option.

When medications and conservative efforts fail and the pain marches on and disrupts your quality of life, it might be time to explore neurosurgery.

In roughly 85% of cases, the compression of your trigeminal nerve stems from a nearby blood vessel, usually the superior cerebellar artery. So, it makes sense that one of the most successful surgeries for trigeminal neuralgia is a microvascular decompression (MVD) procedure.

During this procedure, Dr. Mesiwala makes a small hole in your skull behind your ear and locates the nerve compression. From there, he removes any connective tissues that are contributing to the compression and then places a spacer between the nerve and the blood vessel.

In separating the blood vessel from your nerve through MVD, we can provide you with meaningful relief that lasts — the procedure boasts a 95% success rate, and return of pain after 20 years is fairly low, only about 20%.

We understand that the idea of brain surgery can be daunting, but we assure you that you’re under excellent care at our practice. To explore whether a surgical procedure might be the best path forward for your trigeminal neuralgia, please contact one of our offices in Newport Beach, Marina del Rey, or Rancho Cucamonga, California, to schedule your consultation with Dr. Mesiwala.