Tic douloureux is a painful, paroxysmal, provokable condition causing severe, unpredictable facial pain. In many patients, particularly those under the age of 60, a tortuous brain artery pressing on the trigeminal nerve is the cause.
The Neurosurgery Department has extensive experience with the treatment of this condition using microvascular decompression. The advantage of this technique is that it generally results in a relatively minimal (if any) loss of facial sensation or numbness. Using this technique, an opening is made in the skull and a Teflon pillow is placed between the nerve and the artery to relieve pressure. Extensive clinical practice over the last two decades has proven the procedure to be safe and effective. A safe, less invasive alternative to microvascular decompression is the percutaneous radiofrequency lesion technique, in which a fine electrode in a needle is placed through the cheek into the root of the trigeminal nerve in the skull. This procedure is performed on an outpatient basis, under one-minute anesthesia administered intravenously. The risks of percutaneous radiofrequency are quite low, but may result in a loss of some feeling in the face. Most patients consider this a small price to pay for the incredible relief they get from terrible facial pain. The potential for drooping of the face or facial paralysis from this procedure is virtually nonexistent. Most patients are initially treated with medication, generally Tegretol. For patients who cannot tolerate the side effects of this drug, which may include drowsiness and alterations to the blood count, other medications including Dilantin and Baclofen can be used. Following surgery and symptom relief, many patients find that their ability to be medication-free gives them a new life. All surgical methods, including microvascular decompression and radiofrequency lesion, carry the possibility of pain recurrence. Radiofrequency is usually the best way to eliminate such post-procedural pain. Carlos A. David, MD, is our surgeon with special expertise in tic douloureux.