Jonathan White, M.D.
Department of Neurological Surgery
UT Southwestern Medical Center
5303 Harry Hines Blvd.
4th Floor, Suite 100
Dallas, TX 75390-9167
214-645-2300
Transcript: When to switch from medication management to a surgical procedure?
Another question is when to make the switch from medically managing your face pain to having a surgical procedure such as the microvascular decompression. When I first got out of training I thought I had all the answers to that question but over time I realized that’s a very individual decision and a very personal decision.
Some people get excellent control on their Tegretol or whatever medication they are taking. They have very few side effects from it and those people could go on indefinitely without having surgery.
Other people, the pain seems to break through the medical therapy months or even years after they’ve started it and once the pain is poorly controlled with medical therapy, I think certainly one of the surgical procedures should be tried.
There is some evidence that the longer you have trigeminal neuralgia, the less likely you are to get well with your microvascular decompression and the cut-off seems to be about seven years. In my own practice, I haven’t used that piece of information to encourage people to have early surgery and I’ve relied more on whether or not medical therapy was successful. But I think it probably is true that the longer you have the pain, the less likely surgery is to help you. The purpose of the surgery is to decompress the nerve and once the nerve is permanently injured it may not recover fully to normal.
Other people have a new diagnosis of trigeminal neuralgia but they just don’t want to take the medication. It’s not that they can’t tolerate the medication. It’s not that the medication isn’t working. It’s just that it’s difficult for them to face the fact they have to take medicine every day. I think for those people, it’s acceptable to do surgery on them. If I were in their shoes, I would probably stay on my medical therapy but if you’re really adverse to taking medication and you can find a surgeon who can do the procedure safely, I think it is acceptable to have surgery in that situation.
There is probably a hidden risk to being on medical therapy and all of the medications for trigeminal neuralgia carry side effects and the longer you are on those medications the more chance you are to develop one of those side effects. And so for some people, early surgery may be appropriate.