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A vascular compression syndrome occurs when an artery in the brain compresses a nerve in the head. This compression injures the nerve, resulting in a short circuit of nerve impulses. Depending on the nerve affected, facial pain (trigeminal neuralgia), involuntary facial movement (hemifacial spasm), or deep ear or throat pain (glossopharyngeal neuralgia) may occur. Facial pain is the most common symptom.
Medical Management
The first line of treatment is medication, as it is generally effective and poses little risk. Medications used for vascular compression syndromes are often the same as those used for treatment of epilepsy. Medical therapy is generally well tolerated and usually effective for years. In cases where medicine fails or side effects are intolerable, surgery may be considered.
Surgical treatment
The surgical treatment for trigeminal neuralgia has evolved over the years into two groups: Rhizotomy or radiofrequency procedures, which result in alteration in the nerve to change conduction; and microsurgical procedures, which displace the pressing blood vessel and correct the underlying cause of the nerve dysfunction.
Radiofrequency procedures (RF)
During these procedures, the patient is usually awake and lightly sedated. A long needle is directed through the cheek into a region of the nerve by passing the needle through a hole in the base of the skull called the foramen ovale. The aim of this procedure is to produce a small "lesion" or injury in the nerve. The surgeon must identify the proper portion of the nerve by delivering tiny electrical shocks to the nerve. The patient reports on the perceived location based on the facial stimulation. The patient is then sedated and the needle tip heated using radio waves. RF treatment tends to be very effective and lasts for years, but its effectiveness is correlated to the extent of numbness caused by the lesion.
Microsurgery
When a blood vessel is pressing on the root entry zone, the source of the compression needs to be removed. Through microvascular decompression, the pressing blood vessel is physically moved away from the root entry zone. This procedure is very effective and long lasting, particularly if an artery is found to be compressing the nerve as it enters the brainstem. An advantage of microsurgery is that the procedure preserves nerve function without resulting in facial numbness.
At Lahey Clinic we have extensive experience and expertise in treating these disorders. Radiofrequency and microsurgery procedures are both offered. The type of surgical treatment is individualized according to the needs of each patient, taking the patient's age, and overall health into paramount consideration. When medicine does not provide sufficient relief, surgery provides an effective option for many patients with trigeminal neuralgia.
