Treatment for Trigeminal Neuralgia (TN) at Brigham and Women’s Hospital starts with medication. First line medical therapy includes medications such as carbamazepine or oxcarbazepine. Many other medications can also be used including: baclofen, lamotrigine, levetiracetam, gabapentin, pregabalin, topiramate and botulinum injections. The medications vary in both their efficacy and tolerability.
If medication is no longer serving your needs, our recommendation is highly tailored to your needs. In general, our patients under 65 are encouraged to have the underlying pressure from the blood vessel relieved (MVD), and our patients over 65 are encouraged to undergo the less involved procedures (RFL or radiosurgery).
Microvascular Decompression (MVD) is a microsurgical approach that involves relocating or removing blood vessels that are in contact with the trigeminal root to stop the nerve from malfunctioning. Decompression may reduce sensitivity and allow the trigeminal nerve to return to normal activity. MVD is a more invasive procedure that involves making an incision behind the ear.
Radiofrequency Lesion (RFL). After you are sedated with an intravenous injection (no breathing tube is needed), the neurosurgeon passes an approximately 3-inch-long, pencil lead diameter, probe through the cheek until it arrives in the fibers of the trigeminal nerve. Those fibers are treated by numbing the part of your face where you experience pain. The procedure takes approximately 45 minutes and is done outpatient. Dr. Stephen Saris and Dr. Wenya Linda Bi are the only neurosurgeons in New England who perform this procedure.
Brain stereotactic radiosurgery (Gamma knife) This treatment was developed in Europe over 50 years ago for the treatment of your condition. The treatment begins with the placement of a titanium, see-through box on your head using 4 posts that are put on the forehead and back of your head (see illustration). An MRI is followed by your lying on a table (see illustration) that moves you inside the treatment machine. The experience is very much like undergoing an MRI. It makes some intermittent soft noises, moves you around a bit, and then you are finished. The average treatment time is about an hour. During this time, the treatment machine focuses a large amount of radiation on the trigeminal nerve. The things people often associate with radiation such as fatigue, abnormal blood counts, hair loss, and nausea, rarely occur. The box (frame) is removed, and you are usually home for lunch. In general, anything you did the day before treatment you can do the day after.
To schedule an appointment with a physician in the Neurosurgery Pain Service, please contact our Patient Coordinator at: (617) 732-6600.
If you are a physician seeking to refer a patient to the Neurosurgery Pain Service, please call (617) 732-6600 or you can access our physicians’ office phone numbers here. To contact one of our physicians with a question, patient referral or second opinion, you may also email: BWHNeurosurgery@partners.org.