Dr. Pedro Roldán Ramos
Neurosurgeon · Functional, DBS and FUS
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Facial pain
Trigeminal Neuralgia: Surgical Treatment
Paroxysmal facial pain, electric-shock type, refractory to carbamazepine. Microvascular decompression (MVD) achieves pain relief in 85-90% of cases.
What is it?
Trigeminal Neuralgia: Surgical Treatment
Trigeminal neuralgia is the most intense facial pain known: paroxysmal crises of unilateral electric pain, lasting seconds, triggered by minimal stimuli such as touch, chewing or wind. In its classical form it is caused by the compression of an artery on the trigeminal nerve at its entry into the brainstem. Microvascular decompression (MVD or Jannetta's technique) is the procedure that corrects the cause: it separates the vessel from the nerve through a retrosigmoid craniotomy and achieves pain relief in 85-90% of cases at 1 year.
85-90%
MVD success rate at 1 year
70%
pain-free at 10 years with MVD
3-5 days
typical hospitalisation after MVD
Symptoms
Characteristic symptoms
- Unilateral paroxysmal pain, electric-shock or stabbing type, lasting seconds to minutes
- Located in the V2 (cheek) and V3 (jaw) territory most frequently
- Triggered by touch, chewing, speech, tooth brushing or air currents
- Pain-free periods between attacks
- Initial response to carbamazepine or oxcarbazepine
When to operate?
When to consult a neurosurgeon?
- Failure of carbamazepine, oxcarbazepine or gabapentin at therapeutic doses
- Intolerance to medication side effects (drowsiness, dizziness, hyponatraemia)
- Vascular compression confirmed on brain MRI (FIESTA/CISS sequence)
- Patient in good general health under 70-75 years of age (for MVD)
- Pain recurrence after prior percutaneous technique or radiosurgery
Techniques
Which techniques do we use?
Microvascular Decompression (MVD/Jannetta)
Separation of the vessel compressing the trigeminal nerve through a small retrosigmoid craniotomy. Success rate of 85-90% at 1 year. Technique with the greatest long-term durability.
Stereotactic Radiosurgery
Gamma Knife or CyberKnife: focused radiation dose on the trigeminal root. No incision or general anaesthesia. Latency of 4-8 weeks. Indicated when MVD is not possible.
Percutaneous Rhizotomy
Selective lesioning of the trigeminal root by percutaneous route (balloon, glycerol or radiofrequency). Immediate effect. Higher recurrence rate at 5 years (30%) than MVD.
Team
Neurosurgeons who treat this condition
Results
Prognosis and recovery
Microvascular decompression (MVD) achieves 85-90% success at 1 year and 70% of patients remain pain-free at 10 years. It is the technique with the greatest long-term durability. Stereotactic radiosurgery (Gamma Knife, CyberKnife) has a latency of 4-8 weeks before effect onset and achieves 70-80% pain relief, with less durability than MVD. Percutaneous rhizotomy produces immediate effect but has a recurrence rate of 30% at 5 years. Overall mortality from these procedures in specialised centres is below 1%.
Frequently asked questions
Answers to your questions
What is microvascular decompression (MVD/Jannetta)?
It is a surgical procedure that separates the blood vessel compressing the trigeminal nerve through a small retrosigmoid craniotomy. It achieves pain relief in 85-90% of cases at 1 year and is the technique with the highest long-term cure rate for trigeminal neuralgia.
When is surgery indicated for trigeminal neuralgia?
Surgery is indicated when carbamazepine, oxcarbazepine, gabapentin or other first-line drugs fail to control the pain, produce intolerable side effects, or when the patient is in good general health and is a candidate for a definitive technique. MVD is the preferred option in younger patients with vascular cause confirmed on MRI.
What results can be expected?
MVD achieves 85-90% success at 1 year and 70% at 10 years. Stereotactic radiosurgery has a latency of 4-8 weeks and achieves 70-80% pain relief, with less durability. Percutaneous rhizotomy produces immediate effect but has a higher recurrence rate at 5 years (30%).
Where should trigeminal neuralgia be treated?
At our unit, a multidisciplinary team of neurosurgeons specialised in trigeminal neuralgia using minimally invasive techniques (microvascular decompression, radiosurgery and percutaneous rhizotomy), intraoperative neurophysiological monitoring and a multidisciplinary committee when appropriate. We care for national and international patients with remote second opinions prior to travel.
How to request a second opinion about trigeminal neuralgia?
Send us your medical reports and brain MRI (including the FIESTA/CISS sequence to assess vascular compression of the trigeminal nerve). The team evaluates the case and provides a written report with the recommended strategy within 24-48 hours.
References
What clinical guidelines say
"Microvascular decompression is the surgical technique with the highest long-term pain control rate in classical trigeminal neuralgia of vascular origin."
Bibliography
Scientific references consulted
Studies and clinical guidelines underpinning our approach to this condition.
- Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg. 1967.
- Cruccu G. et al. Trigeminal neuralgia: New classification and diagnostic grading for practice and research. Neurology. 2016. View publication
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International patient
"I travelled from outside Spain. The team reviewed my case before I came and gave me a clear plan. Caring people and impeccable technique."
Request information
Trigeminal neuralgia consultation
Send us your neurologist's reports and brain MRI (including FIESTA/CISS sequence). We will reply within 24-48h.