A Solution for Chronic Neuralgia

This article discusses microvascular decompression surgery, a definitive treatment for trigeminal neuralgia, glossopharyngeal neuralgia, and hemifacial spasm.

Trigeminal neuralgia, glossopharyngeal neuralgia, and hemifacial spasm are neurological conditions affecting sensory or motor functions. The human brainstem, located at the base of the skull, contains twelve cranial nerves. The fifth cranial nerve is responsible for facial sensations (trigeminal nerve), the ninth controls sensations in the mouth, tongue, and throat (glossopharyngeal nerve), and the seventh controls the muscles of the eyes and face (facial nerve).

When these cranial nerves are subjected to pressure or irritation, they can send abnormal signals, resulting in pain in the face, tongue, or throat, or uncontrollable muscle spasms in the eyes and face. The pressure can be caused by a brain tumour, but in most cases, it is due to a small blood vessel loop near the nerve. Various factors, such as cholesterol build-up, high blood pressure, diabetes, smoking, vascular sclerosis, or inflammation, can cause these blood vessels to compress the nerves. Each heartbeat pumps blood through these vessels, and their pulsations can irritate the compressed nerves, leading to erroneous signals similar to a short circuit, causing pain or muscle spasms. Patients may experience excruciating, knife-like, electric-shock pain in the face, teeth, or jaw with each pulse.

When all medications and non-invasive treatments fail to provide long-term relief, microvascular decompression surgery becomes a viable option.

Case Study: Mrs. Cheung's Battle with Trigeminal Neuralgia

Eighty-eight-year-old Mrs. Cheung suffers from trigeminal neuralgia. Initially, she thought the pain was due to a toothache, but even after dental checks and extractions, the pain persisted. A clinical diagnosis by a neurosurgeon confirmed it as trigeminal neuralgia. For over ten years, each episode brought unbearable, electric, and knife-like pain to her face. Everyday activities like brushing teeth, washing face, eating, talking, or even a light touch could trigger the pain. Mrs. Cheung described the pain as more intense than childbirth, affecting her emotionally and socially, causing her to feel depressed.

Initially, doctors use medication to control the condition. However, as time passes, the condition can worsen, and the effectiveness of medication diminishes. Patients may need higher doses or multiple drugs, leading to side effects such as dizziness, drowsiness, and instability. When the condition worsens over time, and medication's side effects significantly impact daily life, minimally invasive neurosurgery becomes an option.

Mrs. Cheung had been treated with various medications in public hospitals for over a decade, but her condition continued to deteriorate. The medication became ineffective, disrupting her ability to speak, swallow, brush teeth, and manage daily activities, also affecting her social life. Even the strongest painkillers failed, causing severe side effects like drowsiness, dizziness, and instability.

Microvascular decompression surgery incision site.

Microvascular Decompression Surgery: Relieving Mrs. Cheung’s Long-term Pain

During Mrs. Cheung’s first consultation at our clinic, she experienced severe right facial nerve pain, making it difficult to speak loudly and causing suicidal thoughts due to chronic pain. After considering other non-surgical treatments (e.g., radiofrequency therapy, radiation therapy, transcranial magnetic stimulation), Mrs. Cheung and her family opted for immediate microvascular decompression surgery (MVD) to relieve the pain. This surgery is performed under a microscope, where the surgeon carefully separates the blood vessel loop from the compressed cranial nerve with less than a millimetre of deviation. Artificial fibres (Telfon Felts) are then implanted to separate the blood vessels from the nerves, acting as a protective cushion against the pulsations caused by the heartbeat.

The success rate of this surgery in curing pain is 90%. Most patients do not experience recurrence and can stop taking nerve pain medication, enjoying a better quality of life. Mrs. Cheung woke up from anaesthesia on the same day of the surgery, immediately noticing the disappearance of her facial nerve pain. She could speak loudly and smile again! She was discharged the next day and has enjoyed a pain-free life without needing any medication.