Trigeminal Neuralgia Treatment Options: From Glycerol Injection to Microvascular Decompression

One of the commonly used non-surgical approaches for managing trigeminal neuralgia is the injection of sterile glycerol or absolute alcohol into the trigeminal nerve ganglion. This procedure, often performed on an outpatient basis, targets the affected nerve to alleviate severe facial pain. It is particularly suitable for elderly or frail patients who are not ideal candidates for more invasive surgeries. The process is minimally invasive and generally does not require hospitalization, making it a convenient option for many.

Limitations of Glycerol Nerve Block

Despite its benefits, the pain relief provided by glycerol injection is often temporary. Most patients experience relief for about 3 to 10 months, after which symptoms may return. In many cases, repeat injections or follow-up visits are necessary within a year, which can be inconvenient and may not offer long-term resolution. This short-term effectiveness highlights the need for more permanent treatment strategies in suitable patients.

Microvascular Decompression: A Long-Term Solution

For those seeking a more lasting and effective solution, microvascular decompression (MVD) surgery offers a promising alternative. Unlike injection-based treatments, MVD is a surgical procedure that requires hospital admission and general anesthesia. The operation involves making a small incision, approximately 5 cm long, behind the ear to access the skull.

How Microvascular Decompression Works

Once access is gained, the surgeon carefully drains cerebrospinal fluid to create space, allowing the cerebellum to shift slightly. This provides a clear view of the trigeminal nerve and any blood vessels compressing it. After identifying the responsible blood vessel, the surgeon places a soft Teflon pad between the nerve and the vessel to prevent further irritation.

By isolating the nerve from pulsating vascular pressure, microvascular decompression effectively stops the transmission of pain signals. This method not only provides immediate relief but also offers high long-term success rates, often leading to complete symptom resolution. As a result, MVD is considered one of the most effective and durable treatments for trigeminal neuralgia, especially for patients who are healthy enough to undergo surgery.