Trigeminal Neuralgia (tic douloureux, TN) is a neuropathic disorder of one or both of the trigeminal nerves (5th cranial nerves). This condition may cause one of the most severe pains that a human being can experience, and may be difficult to control with medications. TN usually develops after the age of 50 and is more common in females. The condition is caused by a vessel (artery or vein) compressing the trigeminal nerve adjacent to the site of its entry into the brainstem. The pain may involve the ear, eye, lip, nose, scalp, forehead, teeth or jaw. The pain is usually described as “stabbing” or “electric-shock” like, and may be brought on or worsened by cold wind, chewing, talking or even touching the face.
Treatment with medications is the first line of defense for patients with trigeminal neuralgia. When medications do not provide adequate control of pain or produce unacceptable side-effects, the possibility of surgical treatment should be considered. For healthy patients, microvascular decompression (i.e. direct decompression of the trigeminal nerve via a craniotomy) is usually the treatment of choice, since it provides the highest probability of long-term relief of pain. For patients who are not healthy enough to undergo a craniotomy or who prefer a less invasive procedure, stereotactic radiosurgery represents a very good treatment alternative, providing long-term pain relief in about two out of three patients.