Surgery for Trigeminal Neuralgia

Trigeminal neuralgia causes brief, intense jolts on one side of the face. It is not just any toothache or a migraine. In Mexico City, it is confirmed through your medical history and an MRI; medication is usually the first step, and surgery is discussed when the pain persists or the medication is no longer tolerated.

Classic pain lasts seconds, feels electric, and is triggered by talking, chewing, wind, or brushing against the skin. It usually affects the cheek or jaw on one side. Dull, constant pain on both sides, or numbness from the start means another cause should be considered before discussing a procedure.

The nerve provides sensation to the teeth and gums, so it is common for people to seek care after extractions that did not relieve the pain. If the pain remains unchanged after appropriate dental treatment, it is best to pause further procedures in the mouth. An MRI looks for a blood vessel compressing the nerve as it exits the brainstem, as well as for a tumor or a multiple sclerosis plaque. Without this imaging, surgery does not make sense.

Carbamazepine or oxcarbazepine is usually the starting point; the clinician following the case prescribes it and monitors you because it can cause dizziness, affect sodium levels, or cause skin reactions. Other medications may be added if needed. This page does not provide dosage instructions. When the pain is controlled with a tolerable dose, there is no rush to operate. Surgery is considered if the flare-up cannot be controlled, if the effective dose causes toxicity, or if the MRI shows clear compression in someone who can accept the risks of an intervention.

Microvascular decompression, performed through surgery behind the ear, separates the blood vessel that is compressing the nerve. It is the most direct option for classic neuralgia if the person can tolerate anesthesia in the posterior fossa. A cerebrospinal fluid leak, hearing changes, or, rarely, a serious complication may occur. Long-term relief is common in typical cases but is not guaranteed. Percutaneous procedures—balloon compression, glycerol, or radiofrequency—are performed through a needle puncture and trade pain for some numbness when open surgery is not advisable. Radiosurgery does not involve cutting the skin and takes weeks to work: it will not resolve tonight’s crisis.

Constant facial pain without electric-shock-like episodes responds poorly to these procedures and may sometimes get worse. In multiple sclerosis, vascular decompression is less effective. The pain may return years later, at which point the options are discussed again. No technique promises a pain-free face without side effects.

If the medication works, do I still have to have surgery? No. Operating on someone whose condition is controlled and who has no serious side effects does not improve the clinical reasoning.

Will decompression leave my face numb? The goal is to separate the blood vessel from the nerve without injuring it. Even so, some degree of numbness or hearing discomfort can occur, and this is discussed beforehand.

Will radiosurgery get rid of my pain the same day? No. If it works, the effect takes weeks. A crisis happening today should be addressed with the person managing your medication, not with a scheduled radiation treatment.

If the electric-shock-like episodes continue despite medication or you can no longer tolerate the side effects, message us at +52 55 2193 8191 and let us know whether you already have an MRI. The public form is not for describing symptoms: during a consultation, we can distinguish typical neuralgia from pain that should not be treated with surgery.