June 20, 2024
Trigeminal neuralgia can be debilitating for patients and challenging to treat. Mayo Clinic's multidisciplinary expertise helps patients receive personalized care.
"As a group practice, we have no incentive to do any particular procedure. We talk about what is best for the patient. That's the core of the Mayo Clinic Model of Care," says Richard S. Zimmerman, M.D., a Mayo Clinic neurosurgeon.
The trigeminal neuralgia team includes neurologists, interventional neuroradiologists, neurosurgeons and psychologists. They take time to thoroughly examine patients, and discuss their pain experiences, before recommending possible treatments.
"As a team, we communicate well among ourselves," says Laine L. Green, M.D., a Mayo Clinic neurologist. "Patients with trigeminal neuralgia don't fit into perfect silos. We are afforded the time to get the detailed information we need for personalized care."
Diagnostic precision and multiple treatment options
Pinpointing the cause of facial pain is key to Mayo Clinic's approach. That starts with a thorough patient history.
"Understanding a patient's early experiences with pain can be very helpful," Dr. Laine says. "We also ask about current pain — its frequency, location, radiation, quality and severity — and what's happening on any pain-free days."
Detailed neurological and physical examinations also are performed, as trigeminal neuralgia can be a manifestation of systemic diseases or conditions. Anatomical issues are considered, including not just the cranial nerves but also the upper neck, eyes, teeth and sinuses.
Additional testing might include:
- Spinal fluid analysis, which can indicate an autoimmune condition.
- Imaging, such as MRI, CT or X-ray.
- Electromyography.
Mayo Clinic's multidisciplinary approach provides patients with a range of treatment options. If medication doesn't work, neurosurgeons can perform microvascular decompression, which involves moving or removing blood vessels that touch the trigeminal nerve to stop its malfunctioning.
"Patients with trigeminal neuralgia don't fit into perfect silos."
Mayo Clinic in Arizona strives to rely on microsurgical transposition and maneuvering of blood vessels to avoid overuse of artificial cushions. They can cause inflammatory tissue or leave continued pressure on the trigeminal nerve and cause recurrent or continued pain.
"There is more than one way to perform this surgery," Dr. Zimmerman says. "We prefer a method that uses the person's own tissue, to be part of a regenerative solution."
Some patients might wish to avoid surgery. Other patients might have medical contraindications for microvascular decompression, such as bleeding disorders, infirmity or inability to undergo general anesthesia.
Mayo Clinic's interventional neuroradiologists can provide nonsurgical procedures, such as nerve blocks. Other nonsurgical treatments that selectively damage the trigeminal nerve to block pain include:
- Pulse radiofrequency ablation, which delivers intermittent bursts of energy to nerve fibers.
- Continuous radiofrequency ablation, which delivers higher energy to nerve fibers.
- Balloon compression, which involves inflating a balloon inside the trigeminal nerve.
- Glycerol injection.
- Stereotactic radiosurgery, which delivers a focused dose of radiation to the base of the trigeminal nerve.
"We prefer to start with the least destructive treatment, which is nerve block," says Ameet C. Patel, M.D., a Mayo Clinic interventional neuroradiologist. "The next step would be pulse radiofrequency ablation and, finally, any of the other treatments."
Neuromodulation is a newer approach that seeks to normalize how nerves function. Transcranial magnetic stimulation, peripheral nerve stimulation, ganglion stimulation and deep brain stimulation might be options.
"A lot of these devices have minimal or no risk and can provide some degree of pain relief," says Jonathon J. Parker, M.D., Ph.D., a Mayo Clinic neurosurgeon. "Neuromodulation is not the first-stage option. We have to understand where the circuitry may be disrupted. This is a very personalized approach."
Multidisciplinary care also encompasses pain rehabilitation. "Even if we can't cure people's chronic pain, we can offer hope that their quality of life can improve," says Cynthia O. Townsend, Ph.D., L.P., a psychologist and the clinical director of the Pain Rehabilitation Center at Mayo Clinic's campus in Arizona. The strategy offers pain management and improved functioning with simultaneous physical and occupational therapies, neuroscience pain education, cognitive behavioral therapy, and relaxation exercises.
"We have many ways to address the needs of patients with trigeminal neuralgia," Dr. Zimmerman says. "Every member of our large, multidisciplinary team contributes to the care of patients."
For more information
Pain Rehabilitation Center. Mayo Clinic.
Refer a patient to Mayo Clinic.