There are several conditions of the cranial nerves (nerves inside the skull) that can be treated with surgery. In most cases, surgery is reserved for patients that have not benefited from medications and are able to tolerate major surgery. In most of these conditions, the nerve is contacted by a blood vessel at its most sensitive site- just as it enters the brainstem. Since the blood vessel pulsates, it is constantly irritating the nerve. Surgery, known as a microvascular decompression, involves separating the nerve and vessel with a small piece of Teflon.
Trigeminal neuralgia
Trigeminal neuralgia is a condition that affects the nerve that sends sensory information from the face back to the brain. The nerve becomes highly irritated, and even the slightest stimulation (touching the face, chewing, brushing the teeth) can cause severe facial pain.
The first line of treatment is medication. If this fails, patients may be considered for other treatment options, including percutaneous rhizotomy, microvascular decompression (MVD), gamma-knife, and other procedures in refractory cases. Microvascular decompression probably has the best long-term success, but it requires an open surgery. For this reason, many patients opt for less-invasive treatments.
Glossopharyngeal neuralgia
This is much less common than trigeminal neuralgia, and in fact, is quite rare. In this condition, the severe nerve pain is in the ear and back of the throat. If symptoms fail to respond to medication, surgery may be an option.
Hemifacial spasm
Uncontrolled spasms of the facial muscles, or hemifacial spasm, can also occur as a result of nerve compression. Medications usually do not help, but sometimes symptoms can be managed by Botox injections. Surgery (microvascular decompression) is an option.
