三叉神经痛

Trigeminal neuralgia is a long‑term pain condition where a main facial nerve misfires and causes sudden, electric‑shock‑like pain on one side of the face. The pain can be extremely intense but is not life‑threatening; treatments often bring strong relief.

1) What is this condition?

It affects the trigeminal nerve, which carries feeling from the face to the brain.
People have bursts of stabbing, shock‑like pain in the cheek, jaw, teeth, lips, or less often the eye or forehead, usually on one side.
Attacks can last seconds to a couple of minutes and may be triggered by light touch, talking, chewing, brushing teeth, or even wind on the face.

2) How serious is it?

It does not damage the brain or shorten life, but pain can be so severe that it disrupts eating, speaking, sleep, and daily activities.
Anxiety and depression are common because people fear the next pain attack.
Many can get good control with medicines or procedures, especially when treated by an experienced team.

3) Non‑surgical treatments

Special nerve‑calming medicines (not simple painkillers):
- Carbamazepine and oxcarbazepine are first‑choice drugs and help about 60–70% of patients.
- Other seizure‑type or nerve‑pain medicines may be added or substituted if needed.
Sometimes muscle‑relaxing or antidepressant‑type medicines for nerve pain.
Counseling, stress management, and support groups to help cope with chronic pain and its emotional effects.

4) Types of surgery / procedures that may be needed

Microvascular decompression (MVD): open surgery behind the ear to move away a blood vessel pressing on the nerve and place a small pad.
Focused radiation (stereotactic radiosurgery, e.g., Gamma Knife): highly targeted radiation to the nerve root to reduce pain signals.
Needle‑based procedures through the cheek (percutaneous procedures): using heat, balloon, or chemical to partially damage the nerve and reduce pain.

5) Goals of surgery vs non‑surgical care

Non‑surgical goals:
- Control pain enough that daily life, eating, and speaking are manageable without major side effects.
- Avoid or delay invasive procedures, especially in people who respond well to medicines.
Surgery/procedure goals:
- Provide longer‑lasting or more complete pain relief when medicines fail, stop working, or cause too many side effects.
- Aim for pain freedom with as little facial numbness or other nerve damage as possible.

6) How surgery can “fix” the problem

MVD physically separates the offending blood vessel from the nerve and pads it, removing the constant irritation thought to trigger misfiring.
Radiosurgery creates a focused “injury” in part of the nerve so it no longer carries pain signals as strongly.
Percutaneous procedures (heat, balloon, or chemical) intentionally damage select nerve fibers to cut pain transmission while trying to preserve basic touch.

7) Risks of surgery (general and specific)

General risks: infection, bleeding, blood clots, anesthesia‑related problems.
MVD‑specific:
- Facial numbness, hearing loss on one side, balance problems, spinal fluid leak, or, rarely, stroke or serious infection.
Radiosurgery / needle‑based procedures:
- Facial numbness or tingling, sometimes bothersome; rarely a burning painful numbness.
- Pain may return over time, requiring repeat treatment.

8) Chances this surgery will work

MVD: about 70–80% of well‑chosen patients have long‑term major pain relief, often without ongoing medicines.
Radiosurgery and percutaneous procedures: many patients get good relief, but pain freedom rates are generally lower and recurrence rates higher than MVD.
Best results occur when imaging shows a clear blood vessel pressing on the nerve and when classic “electric shock” symptoms are present.

9) Possible complications from the surgery

Persistent or new facial numbness, which may be mild or, rarely, painful.
Hearing changes (mostly with MVD), balance issues, or spinal fluid leak needing repair.
Pain returning months or years later, sometimes requiring repeat procedures or a switch back to medicines.

10) Typical recovery from the condition

With medicines, many people have fewer and milder attacks, though dose changes or extra drugs are often needed over time.
Some live for years with only occasional flares; others have more frequent cycles of worsening and improvement.
Emotional support and good pain management can help maintain work, relationships, and sleep even if some pain continues.

11) Typical recovery after surgery

MVD:
- Hospital stay of a few days; incision behind the ear with headache, neck stiffness, and fatigue for several weeks.
- Many patients feel facial pain gone or much reduced immediately after surgery; full recovery can take 4–8 weeks.
Radiosurgery / percutaneous:
- Usually outpatient or overnight; mild facial soreness or numbness.
- Pain relief may be delayed by days to weeks, especially after radiosurgery.

12) How long in the hospital

MVD typically requires 2–4 days in the hospital if recovery is smooth.
Radiosurgery and needle procedures are often same‑day or overnight stays.

13) Long‑term outlook

Trigeminal neuralgia is a chronic condition, but many people achieve long stretches—sometimes years—of little or no pain with the right mix of medicines and/or procedures.
MVD offers some of the most durable relief; long‑term success around 70–80% is reported when there is clear vessel‑nerve compression.
Even when pain returns, additional procedures or medicine changes can often restore good control.

14) Need for outpatient follow‑up

Regular visits with a neurologist or pain/neurosurgery specialist to adjust medicines and monitor side effects.
After surgery, follow‑up checks look for wound healing, hearing or balance issues, numbness, and how well pain is controlled.
Long‑term, many people benefit from periodic reviews of pain control, mental health support, and discussion of further options if pain changes