Article: Trigeminal neuralgia is a progressive condition. Although medications can help you manage symptoms over time, more aggressive cases of this condition can lead to permanent damage to the trigeminal nerve, which can result in debilitating pain or partial permanent facial numbness. If you do not respond to medication surgery may be considered.  Your doctor will work with you to help you choose the best surgery based on your health and medical background. The degree of severity of your trigeminal neuralgia, prior history of neuropathy, and general health all factor into the options that are available to you. The overall goal of surgery is to minimize damage to the trigeminal nerve as trigeminal neuralgia advances and to improve quality of life when medications no longer effectively manage pain. The goal of balloon compression is to slightly damage the trigeminal nerve branches so that pain impulses cannot be transmitted.  During the procedure, a small balloon is inserted into the skull through a catheter and as it inflates, the trigeminal nerve is pressed against the skull. This is typically an outpatient procedure that is performed under general anesthesia, although sometimes an overnight hospital stay is needed. Balloon compression results in about two years of pain relief. Many patients experience temporary facial numbness or weakness in muscles used for chewing after undergoing this procedure, but are generally relieved of pain symptoms. Glycerol injection is used to treat trigeminal neuralgia that particularly affects the third and lowest branch of the trigeminal nerve.  During this outpatient procedure, a thin needle is inserted through the cheek into the base of the skull and near the 3rd division of the trigeminal nerve. Once the glycerol is injected, it damages the trigeminal nerve, resulting in pain relief. This procedure usually results in about 1 to 2 years of pain relief. Radiofrequency thermal lesioning, also known as RF ablation, is an outpatient procedure consisting of coagulating nerve fibers with an electrode to desensitize areas where you experience pain.  During the procedure, a needle with an electrode is inserted into the trigeminal nerve. Once the area of nerve that causes the pain is located, your doctor sends small electrical pulses through the electrode to damage the nerve fibers, resulting in numbing of the site. In about 50% of the patients, the symptoms reoccur three to four years following the procedure. This procedure uses computer imaging to send focused radiation to the trigeminal nerve.  During the procedure, the radiation creates a lesion of the trigeminal nerve, which disrupts sensory signals to the brain and reduces pain. Patients can often leave the hospital the same day or the day following the procedure. Most patients who undergo gamma knife report pain relief after a few weeks or months but pain often reoccurs within three years. MVD is the most invasive surgical procedure for trigeminal neuralgia. During surgery, your doctor makes a hole behind the ear. Then, using an endoscope to visualize the trigeminal nerve, your doctor will place a cushion between the nerve and the blood vessel that compresses the nerve.  The recovery time for this procedure varies from person to person and often requires a hospital stay. This is the most effective surgical treatment for trigeminal neuralgia. About 70-80% of patients have immediate, complete pain relief and 60-70% remain pain-free at 10-20 years. Neurectomy involves removing a part of the trigeminal nerve. This invasive, ablative procedure is reserved for patients who are refractory to other treatments or who cannot undergo alternative surgical procedures.  Neurectomies may work for treating trigeminal neuralgia, but most evidence has been negative or inconclusive. Neurectomies are often performed when a blood vessel is not found pressing on the nerve during an MVD. During the procedure, different portions of the trigeminal nerve's branches are removed to grant pain relief.

What is a summary?
Ask about surgery. Try balloon compression. Ask about glycerol injection. Try radiofrequency thermal lesioning. Research stereotactic radiosurgery (or gamma knife). Try microvascular decompression (MVD). Understand neurectomy.