Vascular Compression Syndromes
Trigeminal Neuralgia
Trigeminal neuralgia is also known as Tic Douloureux. It is a disorder of the fifth cranial nerve (called the trigeminal nerve), which is one of the largest nerves in the head. The trigeminal nerve and its branches send impulses such as touch and pressure to the brain from the face and forehead, jaw and gums, and the area around the eyes. TN causes sudden, intense, electric-shock like episodes of pain in these areas.
The pain episodes usually last for several seconds, and sometimes repeat one after another. The disorder usually affects one side of the face. Women are more likely to be affected than men, and the vast majority of cases affect patients over the age of 50.
Pain episodes can be triggered by the most mundane of activities, such as talking, eating or even putting on make-up. The episodes may occur throughout the day and may continue for a few days, weeks or months, before unexpectedly stopping. The condition may then recur at a later date.
The exact cause of trigeminal neuralgia is unknown. However, many experts believe that it is caused by a vein or artery compressing the trigeminal nerve.
Atypical trigeminal neuralgia is far less common, and is characterized by less intense pain, but more constant aching pain.
Treatment Options
The initial treatment of trigeminal neuralgia is usually medication. Anti-convulsant and some anti-depressant drugs have been shown to have significant pain-relieving effects. Your doctor will monitor your progress on these drugs, and check for any side-effects. If medication is not effective, or produces unacceptable side-effects, your doctor may recommend surgical options.
The most common surgical option is a microvascular decompression. The surgery involves a small incision behind the ear, followed by removal of a small part of the skull to create a “window” through which the surgeon can access the trigeminal nerve. At this point, any blood vessels putting pressure on the nerve are carefully separated from the nerve. The procedure has a high success rate, but, as with all surgical procedures carries some risks. Your doctor will carefully discuss these potential risks with you.
Conclusion
Trigeminal neuralgia is a very painful disorder. However, it is not fatal. Pain episodes tend to occur for a period, then stop, and them often recur again. Many patients experience relief with medications, and others receive relief from surgery.
Hemifacial spasm is a condition characterized by frequent, painless, involuntary contractions of muscles on one side of the face. The symptoms usually begin with muscle spasms around the eye and then progresses to involve the entire side of the face.
The cause of hemifacial spasm is usually due to a blood vessel, usually an artery, compressing the seventh cranial nerve (known as the facial nerve). The facial nerve supplies the muscles that control facial expression.
It is important to distinguish hemifacial spasm from another condition that has similar symptoms, namely facial myokymia. Facial myokymia causes continuous facial spasms, and is usually caused by multiple sclerosis or other serious conditions.
Treatment Options
There are three main options for the treatment of hemifacial spasm, medication, injections and surgery.
Medication
In mild cases, your physician may prescribe drug therapy. Various drugs have been used for treatment and the result shave on occasion been encouraging, but overall mixed.
Injections
Physicians have reported good results with injections Botulinum toxin (Botox) into the affected facial muscles. The injections can stop spasms for several months, but usually need to be repeated as symptoms will recur. Complications such as a drooping eyelid can occur.
Surgical Approach
When the symptoms are severe and the cause is thought to be due to a blood vessel impinging upon the facial nerve, surgery may be prescribed. The procedure of choice is microvascular decompression. The surgery involves an incision behind the ear. The neurosurgeon will then remove a small section of the skull to create a “window” through which access to the facial nerve is gained. At this point, any vessels putting pressure on the nerve are separated from the nerve. Surgery results depend on the age of the patient (with younger patients often doing better) and the duration of symptoms. Possible complications of surgery include hearing loss on the side of surgery, and short term or permanent facial weakness.
Conclusion
While hemifacial spasm is an upsetting disorder for patients, it is usually not painful not life threatening. Treatment can be successful although results vary, with successful outcomes most likely in younger patients with only a short history of symptoms.
Glossopharyngeal Neuralgia
Glossopharyngeal neuralgia is characterized by severe pain in the throat and the base of the tongue that may radiate to the ear and/or neck. Pain episodes can be intermittent or relatively persistent. Other symptoms can be excessive salivation and coughing. Symptoms of the disorder can be triggered by such daily activities as swallowing, sneezing or talking.
Treatment Options
Prescription drugs may be prescribed to alleviate pain. However, in severe cases surgery may be prescribed. The surgery will involve either a nerve division or a microvascular decompression. A microvascular decompression will involve the surgeon carefully approaching the nerve through the skull and separating the nerve from any vessels that are causing pressure.
Conclusion
For many patients, prescription drugs make the pain tolerable. When surgery is necessary, most individuals have very good results.
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