In certain cases, trigeminal neuralgia can be effectively treated by radiosurgical treatment with sub-millimetre precision. The surrounding healthy tissue is protected as much as possible. The treatment lasts an average of 30 minutes, is a one time treatment and is carried out on an outpatient basis. If trigeminal neuralgia is treated with a radiosurgical procedure, the somatosensory sensations in the face might be affected but remain in many cases.
Study results indicate that the Cyberknife system is a safe and effective treatment option for people with trigeminal neuralgia.
Definition – trigeminal neuralgia
Trigeminal neuralgia is an extremely painful disease of the nerve of the same name (nervus trigeminalus). It causes sudden, lightning-fast, strong attacks of pain in the face. There are twelve “cranial nerves” in total, the trigeminal nerve being the fifth of these nerves. The trigeminal nerve informs the brain about sensations from the facial skin area. However, this function is disturbed in trigeminal neuralgia. The nerve therefore sends the strongest pain to the brain, although the skin is intact and not exposed to any damage.
The International Headache Society (IHS) divides trigeminal neuralgia into two different groups based on the causes, symptomatic trigeminal neuralgia and classic trigeminal neuralgia.
Trigeminal neuralgia causes some of the most severe pain of all, and many suffer from severe facial pain attacks. The pain associated with trigeminal neuralgia usually only lasts for a few seconds (rarely longer than 2 minutes). Most patients are symptom-free between attacks of pain. The symptoms of trigeminal neuralgia can occur in the entire supply area of the trigeminal nerve, i.e. in the entire face and especially in the area of the cheeks, lips, tongue and chewing muscles. The causes have not yet been fully clarified, which makes trigeminal neuralgia therapy difficult.
Trigeminal neuralgia differs from trigeminal neuropathy. This is a permanent pain that has other causes and is difficult to treat in principle. There are also mixed forms of neuralgia and neuropathy.
Trigeminal neuralgia is a rare disease. About four out of 100,000 people develop trigeminal neuralgia for the first time each year. Classic trigeminal neuralgia only occurs at an advanced age, around 70% of those affected are older than 60 when the disease develops. Women get sick more often than men.
Conservative methods (medication, acupuncture, etc.) or surgical methods are available for the treatment of trigeminal neuralgia, with which effective pain relief can be considered.
In the surgical forms of treatment, an attempt is made to eliminate possible painful stimuli. It has been suggested that the facial nerve may be pinched by a blood vessel, usually an artery, on its way to the brainstem. As a result, the nerves that may have been damaged by pressure can also cause pain with painless stimuli. This is noticeable to the patient as bouts or attacks of pain in the face.
As a result, an operation was developed in which this blood vessel is padded by the nerve (so-called microvascular decompression). Nowadays the operation is named after Peter J. Jannetta (USA). The nerve is not damaged during the Jannetta operation and in most cases (80-95%) the neuralgia is significantly better or completely gone after the operation and the long-term results with approx. 70% pain-free patients after 5 or 10 years are good.
If this operation is not possible for various reasons, pain relief or freedom from pain can be achieved for several years by so-called lesional, i.e. nerve-damaging interventions. In this case, the inhibition of pain transmission occurs via heat, alcohol or pressure-mediated damage to the nerve fibers in the area of the nerve node at the base of the skull (Ganglion Gasseri or trigeminale). The effect of these methods decreases over the long term and the neuralgia attacks can reoccur, so that these interventions may have to be repeated.
Targeted irradiation of the trigeminal nerve is a newer non-surgical treatment option.
Cyberknife or ZAP can be used to irradiate the nerve just before it enters the brainstem in a targeted manner and with sub-millimetric precision. Within a few weeks the pain gets typically better. This special radiation technique can only be carried out at specialized centers and facilities with dedicated high precision treatment systems.