Typical trigeminal neuralgia (facial tic) patients suffer from terrible electrical “lancinating” pain in the face. The pain arises from a physical conflict between a brainstem artery (usually one or more branches of the “superior cerebellar artery“) and the trigeminal nerve (Image 1) at its brainstem (pons region) entry region (“root entry zone“). This physical “pulsatile” neurovascular conflict (NVC; Image 2 FIESTA or CISS MRI image) causes abnormal (“ephaptic“) transmission in the nerve, and this manifests as the severe bouts of pain that is often triggered by, e.g., teeth-brushing, wind on the face, stroking the face, chewing, talking etc. The pain is often incredibly debilitating, sometimes it lessens and then returns with severity.

If the pain does not respond well to medications from your G.P. or neurologist, the condition can be readily treated by a suitably experienced cerebral microsurgeon in an operation referred to as microvascular decompression (MVD).

I often encounter patients who have suffered for years with debilitating trigeminal neuralgic/tic facial pain before having the MVD/microvascular decompression surgery under my care. I have written a blog on this (Please click here to access that blog, and then use the link at the bottom of that blog to return to this page).

Patients with trigeminal neuralgia should NOT feel that “nothing can be done” for their pain, NOR should they undergo any potentially destructive radiation of the brainstem as the first-line treatment, when there is a typically safe and effective time-tested and minimally invasive microsurgical solution that does not involve any entry into or destruction of brain tissue.

Patients with suspected trigeminal neuralgia should be appropriately imaged (via, e.g., dental OPG and brain MRI/A) to ensure that there is no tooth abscess, or any multiple sclerosis plaque or other structural lesion (i.e., skull base or posterior fossa tumour or vascular mass) in or near the ‘pons’ and/or trigeminal ganglion and/or skull base trigeminal nerve branches, that may be causing the facial pain.

The trigeminal nerve is surgically decompressed using a combination of micro-instruments to free up the local neurovascular tissues, followed by placement of tiny (1-1.5mm) pledgets of teflon (PTFE) between the offending vessel(s) and the trigeminal nerve trunk. I use a total of 4 technical steps to improve the anatomy and physiology of this brainstem region, for the better. My craniotomy reconstruction techniques are carefully designed to provide structural and cosmetic integrity.