Another group of focused ultrasound leaders considers that trigeminal neuralgia is a given localization of neuropathic pain. Therefore, they treat this syndrome like any other form of neuropathic pain, and this approach began prior to focused ultrasound treatments. Currently, they perform a type of medial thalamotomy which has been shown to provide an average pain relief of 60 percent, and which does not bring a risk of iatrogenic pain production nor produce somatosensory deficits. This group is treating trigeminal neuralgia as part of the neuropathic pain CE approval in Europe.
Percutaneous stereotactic rhizotomy treats trigeminal neuralgia by burning the nerve. It can relieve nerve pain by destroying the part of the nerve that causes pain and by suppressing the pain signal to your brain. The surgeon passes needle through the skin of your cheek into the trigeminal nerve. A heating current, which is passed through the electrode, destroys some of the nerve fibers. Unfortunately, it is destructive and has a high incidence of facial numbness, and also may cause a different type of facial pain as a side effect (anesthesia dolorosa). As a result of these limitations, we rarely recommend this form of treatment.
The diagnosis of idiopathic trigeminal neuralgia (TN) is tenable only if no physical findings of fifth nerve dysfunction or are present. Neurologic examination findings are normal, and facial sensation, masseter bulk and strength, and corneal reflexes should be intact. Thus, no sensory loss is found unless checked immediately after a burst of pain; any permanent area of numbness excludes the diagnosis. Loss of the corneal reflex also excludes the diagnosis of idiopathic trigeminal neuralgia, unless a previous trigeminal nerve section procedure has been performed. Any jaw or facial weakness or swallowing difficulties suggests another etiology.