Sharp, stabbing pain in the face, throat, ear or scalp may be a symptom of compression of one of the cranial nerves as they leave the brainstem. This pain can be truly disabling, but fortunately there is very effective treatment in the form of medications, surgery, or radiation. Trigeminal neuralgia is the most common of this group of disorders, and is caused by compression of the fifth cranial nerve, typically by an artery (so-called “neuro-vascular conflict”).
Prior to any treatment for trigeminal neuralgia, other causes such as tumor, multiple sclerosis, or shingles need to be ruled out with appropriate imaging studies. In addition, prior to considering any invasive treatment for trigeminal neuralgia, patients must first be treated medically or conservatively, since most patients will respond very well to medications for this disorder.
Although compression of the fifth cranial nerve is the most common neuro-vascular conflict encountered, arterial compression of any of the cranial nerves may cause significant symptoms. Compression of the seventh cranial nerve may cause hemifacial spasm, if the motor fibers are primarily affected, or may cause otalgia (ear pain), if the small sensory branch of the seventh nerve is primarily affected. Compression of the eighth cranial nerve is a rare cause of disabling vertigo, similarly treated by microvascular decompression. Meniere’s disease is a more common cause of vertigo, treated effectively by sectioning of the vestibular division of the eighth cranial nerve.
At House, we employ a variety of tools in our ‘armamentarium’ to combat facial pain and its related disorders, including microvascular decompression surgery, Gamma Knife radiosurgery, and peripheral procedures such as rhizotomy or neurectomy.
Facial pain syndromes and disorders of the cranial nerves include: