Neuralgia

Neuralgia is nerve pain and symptoms which afflict a large amount of the population. It's the kind of pain following an injury to the sensory nervous system eg to a peripheral nerve. Neuralgia  is  difficult to treat and requires significant involvement of neurosurgery. It usually occurs suddenly while other times it gradually sets in and  longer lasting making life difficult for the patients.

There are many times when neuralgia can impede business and other activities of patients. We must also keep in mind that even some medication such as an analgesic may not bring positive results and patients continue to suffer.

Infectious diseases such as various viruses are among the most common factors to be able to affect the nerves and cause neuralgia. One of the most commonly known viruses that attack the nerves is perhaps the virus of herpes zoster.

Trigeminal neuralgia

The trigeminal neuralgia is a special condition of facial pain, which follows the pathway of the trigeminal branches. The trigeminal nerve is sensory and supplies the face, cornea and teeth, the meninges and arteries of the brain. The clinical manifestation of trigeminal neuralgia consists of paroxysmal, short but very painful attacks. Usually located on the lower lip and mandible or upper lip and palate, but can also be found in the nose and the ipsilateral periocular area.

In 90% of patients the disease begins after the  age of 40 and is more common in women. The pain levels are triggered intermittently by painful sensitivity in specific areas of the face. The types of sensitivity are touch, speech, chewing, swallowing, head movements, exposure to cold breeze, washing face and brushing teeth.

Some patients continue to function with pain while others develop disabilities,   become undernourished and develop depression. The most common cause is trigeminovascular compression, ie compression of the nerve root by an arterial branch. Hypertension and multiple sclerosis are risk factors.

Magnetic resonance imaging and magnetic resonance angiography now allow visualization and confirmation of the existence angio neural compression of the trigeminal and bring indisputable indication for surgical decompression. Surgical treatment is indicated in patients who failed previous therapeutic procedures ie medication resistant neuralgia or for patients who can not tolerate the side effects of medications.

In recent years percutaneous thermocoagulation of the ganglion semilunare Gasseri is conventional, percutaneous injection of ethanol or glycerol in  the gasterio ganglion and microvascular or trigeminovascular decompression after craniotomy performed under anesthesia.

The most prevalent treatment today is microvascular decompression. With the microsurgical technique the root of the trigeminal is decompressed from pressure from arteries, veins or even adhesions, by the insertion of small implants of mater, silicone sponge or polyvinyl alcoholic small pieces of Teflon to permanently separate  the vessel from the nerve, resulting in immediate relief  with a small percentage of relapse or limited success.