Trigeminal Neuralgia Surgery and Treatment in India

What is Trigeminal Neuralgia?

Trigeminal Neuralgia (TN) or tic douloureux is a chronic, debilitating condition characterized by intermittent, intense and excruciating one-sided facial pain. The pain is periodical and episodic which lasts from a few seconds to several minutes. The Trigeminal nerve is the largest cranial (head) nerves which radiates to ophthalmic, maxillary, and mandibular. Most commonly the maxillary and/or mandibular branch is involved. It sends impulses of touch, pain, pressure, and temperature to the brain from the face, jaw, gums, forehead, and around the eyes.

Causes of Trigeminal Neuralgia:

• Compression of the trigeminal nerve by an adjacent blood vessel
• Demyelination (loss of nerve covering) of the trigeminal nerve
• Stress and anxiety
• Genetic tendency
• Tumor and Multiple Sclerosis (in rare cases)
• Unknown causes

Diagnosis of Trigeminal Neuralgia

Trigeminal neuralgia is recognizable by patient history alone and is diagnosed by his description of the symptoms. Magnetic resonance imaging (MRI) can be used to determine whether a tumor or multiple sclerosis is irritating the trigeminal nerve. MRI is performed to rule out other causes of compression of the trigeminal nerve such as mass lesions, large ectatic vessels, or other vascular malformations. Otherwise, no test can determine with certainty the presence of trigeminal neuralgia.

Symptoms of Trigeminal Neuralgia

Trigeminal Neuralgia presents itself as facial pain and headache which is sudden, sporadic, electric shock-like and intensely agonizing. Depending on which part of the nerve is affected (ophthalmic, maxillary, and mandibular) the symptoms will be experienced in those areas. Skin contact (shaving or washing), brushing teeth, oral intake, exposure to wind, etc can trigger the pain. Patient is usually pain-free in between the attacks of TN.

Treatment of Trigeminal Neuralgia

• Medical
• Surgical

Medical Treatment for Trigeminal Neuralgia:

The goal of initial medical treatment is to achieve pain relief. Anticonvulsants drugs like carbamazepine (Tegretol, Mazetol- trade names) or gabapentin are the first line drug. However, there is a need for further randomized clinical trials to establish the effectiveness of these medications. Once patients have been in remission for 1 month the dosage should be gradually reduced and withdrawn.

• Carbamazepine may not be as effective for Atypical Trigeminal Neuralgia.
• Some Tricyclic antidepressants drugs also have significant pain relieving effects.
• If medications are ineffective or if they produce undesirable side effects such as lethargy, loss of memory, nausea, weakness of bones (osteoporosis), giddiness, low energy, etc., neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity.

Surgical Treatment for Trigeminal Neuralgia:

There are various types of surgical procedures that can be used in trigeminal neuralgia:

• Glycerol Injection
• Microvascular Decompression
• Balloon Microdecompression
• Stereotactic Radio Surgery
• Percutaneous Steriotactic Radiofrequency Rhizotomy – Electrocoagulation

Microvascular decompression (MVD) is often preferred for younger patients with typical trigeminal neuralgia. High initial success rates (>90%) have led to the widespread use of this procedure. This procedure provides treatment of the cause of trigeminal neuralgia in many patients.

Percutaneous transovale needle techniques include radiofrequency trigeminal electrocoagulation, glycerol rhizotomy, and balloon microcompression.

Percutaneous techniques are advocated for elderly patients, patients with multiple sclerosis, patients with recurrent pain after MVD, and patients with impaired hearing on the other side; however some surgeons recommend needle techniques as first surgical treatment for many patients. It is generally agreed that MVD provides the longest duration of pain relief while preserving facial sensation. In experienced hands, MVD can be performed with low morbidity and mortality.

Trigeminal Neuralgia Radiosurgery

Radiosurgery is performed by delivering a high dose of ionizing radiation in a single treatment session using multiple beams. Several reports have documented the efficacy of Gamma Knife‚ stereotactic radiosurgery for trigeminal neuralgia. Because radiosurgery is the least invasive procedure for trigeminal neuralgia, it is a good treatment option for patients with co-morbidities, high-risk medical illness, or pain refractory to prior surgical procedures.

Prognosis

Over time the pain of TN usually becomes more severe and more frequent, requiring higher dosage and more continuous usage of medications. As a result, many patients whose pain was initially well controlled with medication find over time that they must increase to toxic levels in order to control their pain. At this point, they require surgical intervention.

Benefits of Trigeminal Neuralgia Surgery and Medical Treatment:

Success rates with all surgical procedures are generally good with almost 3/4 of patients being positively affected.

• Percutaneous microballoon compression is safe for elderly patients.
• However, nearly all procedures cause some numbness and in a few these can be associated with intense pain obviating the whole point of the surgery ("anaesthesia dolorosa").
• Microvascular decompression, although more risky, is increasingly used as it provides the longest period of pain relief and there is no sensory loss.
• Success rates (>90%) have led to the widespread use of MVD procedure.

Trigeminal Neuralgia Surgery and Treatment in India

India is widely known in the world for its world-class medical and health care services. It is increasingly emerging as the destination of choice for a wide range of medical procedures. There are several reknowned neurosurgeons who are expert in handling many neuro diseases including Trigeminal Neuralgia. India has many private hospitals that are custom designed to provide world-class medical and health care in India. These hospitals utilize some of the best medical equipments of the world People are attracted towards the best quality of healthcare services, accredited medical facilities, and internationally trained and qualified health care professionals and travel to India for their health care needs. India is a very lucrative destination for people wanting to undergo treatment of certain medical problems who do not need immediate emergency treatment.

Cities in India that offers Treatment and Surgery for Trigeminal Neuralgia are;

Cost of Trigeminal Neuralgia Treatment and Surgery in India

India is the most cost effective medical tourism destination of the world. The cost in India for Trigeminal Neuralgia is very low as compared to cost offered by most western countries. This applies to treatment and surgeries associated with Trigeminal Neuralgia. Even after adding travel and accommodation costs, treatment of Trigeminal Neuralgia in India can result in up to 50 to 80% cost savings. All surgery and treatments are tailored and developed to consider the needs of the travelling patient. India gives you the opportunity to have high class immediate surgical and medical treatments which includes Trigeminal Neuralgia Treatment and Surgery in India

Some of the common countries from which patients travel to India for surgery are:

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