What does the trigeminal nerve do? The trigeminal nerve is the largest nerve in the human face, and it is mainly responsible for pain, touch and muscle movement in the human face. For example, when the wind blows on the face, it feels cold, which is the sensation of the trigeminal nerve. When we bite something with strength, this is the role of the trigeminal nerve motor innervated muscles. What can cause trigeminal neuralgia? There are many causes of trigeminal neuralgia, generally speaking, they are divided into two aspects. One is that the trigeminal nerve is compressed by the blood vessels in the cranium, and as the blood vessels expand and beat, they cause impact on the trigeminal nerve, which causes trigeminal pain. Another reason is that the trigeminal nerve has a very thick ganglion in the skull. This ganglion is called the trigeminal hemimelia. Small tumors growing in the ganglion, or ischemia or viral infection in the ganglion can cause trigeminal neuralgia. What symptoms can be diagnosed as trigeminal neuralgia? Trigeminal neuralgia is a condition that typically presents with paroxysmal, severe pain in the area of the face innervated by the trigeminal nerve. The nature of the pain is electric and knife-like. After excluding other diseases, it is easy to diagnose. This means that the diagnosis of this disease is very easy, but its treatment is more difficult. What are the characteristics of trigeminal neuralgia pain? Trigeminal neuralgia is characterized by pain that is episodic and very intense. The patient feels a pain like a cut or an electric shock. The pain comes on very suddenly, often lasting a few minutes and then suddenly relieved. Sometimes the pain comes on suddenly while the patient is being seen, and the patient lies on the floor and rolls around in pain. This pain can be relieved for a period of time, after a period of pain. Some periods of relief can last for tens of days, and then a cycle of attacks begins again. The pain is so excruciating that some patients become unbearable and seek suicide. What treatments are available for trigeminal neuralgia? There are many treatments for trigeminal neuralgia, mainly divided into three categories, which are recognized as effective both domestically and internationally. The first method is medication, which mainly allows patients to take oral medication, the most prominent drug is called carbamazepine, which is effective for many patients. Patients may prefer to take oral carbamazepine for pain relief. The second method is minimally invasive interventional treatment, also known as radiofrequency disruption of the trigeminal hemianopia. This method involves placing a very thin radiofrequency needle into the trigeminal meningeal ganglion. The tip of this needle can be heated to 70 to 80 degrees, causing a slight denaturation of the proteins within the meningeal ganglion so that pain signals cannot be transmitted. The third method is functional neurosurgery, also called microvascular decompression. It involves opening the back of the head to relieve the compression of blood vessels on the trigeminal nerve. These three methods can be used separately for patients with different levels of pain. What are the more common oral medications used internationally now? If some patients are allergic to carbamazepine and cannot take it, they can also consider taking another drug, phenytoin sodium, which is also effective for some patients. Is there a complete treatment for trigeminal neuralgia? What is the risk of cure? In what hospital is there a more proven method for this? The proven methods of treating trigeminal neuralgia that are recognized nationally and internationally are radiofrequency disruption of the semilunar ganglion and microvascular decompression. Both of these methods, if used in a standardized manner, will provide patients with long-term pain relief and have a very low recurrence rate. These treatments are available in many major hospitals in China. In Xuanwu Hospital, these two treatments are carried out in two departments, mainly CT-guided radiofrequency destruction of the trigeminal nerve in the pain department and microvascular decompression in the functional neurosurgery department. If possible, you can come and have a look. What is microvascular decompression surgery all about? Microvascular decompression is a craniotomy in neurosurgery to treat trigeminal neuralgia. After the craniotomy, the artery that affects the trigeminal nerve is first found, usually by MRI before surgery to confirm that there is a blood vessel compressing the trigeminal nerve root. The vessel is then separated from the trigeminal nerve root, and a soft pad is placed between the vessel and the nerve so that the vessel no longer impinges on the nerve. Some patients do not do well on very large doses of carbamazepine. What are the side effects of long-term use of the drug in such patients? Carbamazepine is relatively safe if taken in small doses, but there are many side effects if taken in large doses and for long periods of time. For example, a large amount of prolonged use can cause damage to liver and kidney function, and we have also encountered serious patients who even led to kidney failure and a kidney transplant. Another side effect of carbamazepine is that it can cause persistent insomnia. Once this insomnia is formed, it is not easy to cure. Another more serious side effect is exfoliative dermatitis. The patient’s skin may peel, ulcerate, and become painful, and the patient’s internal mucosa may also peel easily, which may lead to gastrointestinal bleeding in severe cases. In addition, long-term use can also lead to damage to the hematopoietic system, and in severe cases, patients may develop aplastic anemia. Therefore, patients who take high doses of the drug for a long time should go to the hospital regularly to check their liver and kidney functions and blood count, preferably once a month. Once abnormal changes in these functions are detected, the drug should be discontinued in a timely manner. It is also important to pay attention to the occurrence of drug insomnia if you do not sleep well during the medication.