Trigeminal Neuralgia & Hemifacial Spasm
The trigeminal nerve is the fifth cranial nerve that supplies the sensation to the face. Trigeminal neuralgia occurs when there can be compression of the nerve as it’s coming of the brain most commonly by an artery or tumor but sometimes the etiology is unknown. This can cause severe episodic stabbing, electrical sensation in the face that could be triggered by minor things such as chewing.
Treatment is usually initiated with medications. Patients may initially respond well but later either start experiencing frequent episodes or stop responding to medications. Surgical treatment includes direct decompression of the nerve from the offending vessel via small incision behind the ear where a piece of bone is removed from the skull to access the brain where the trigeminal nerve is located. The offending artery is then gently lifted off and small piece of synthetic material is placed between the nerve and the artery to prevent the artery from directly contacting the nerve. In experienced hands, this provides the highest success rates and best long-term relief. Other options include glycerol or alcohol injections directly to the nerve and gamma knife surgery
At WNS we work closely with primary care physicians to make treatment plans based on responsiveness to medication, age and overall medical health to offer the best management for our patients through either injections, microvascular decompression and gamma knife surgery.
The seventh cranial nerve supplies the muscles to the face. In hemifacial spasm there can be compression of the nerve by an artery, which can irritate the nerve and make it hyperactive. Patients can get uncontrolled spams and twitching of the facial muscles on the side of the nerve being affected. Treatment options include Botox to temporarily relax the facial muscles.
Surgical option includes microvascular decompression, much like the approach for trigeminal neuralgia, in which a small piece of synthetic material is placed between the nerve and the offending artery.