Trigeminal neuralgia and hemifacial spasm are cranial nerve disorders caused by compression of the trigeminal and facial nerves as they emerge from the brainstem.
What are cranial nerve syndromes?
Cranial nerve syndromes occur when one or more of your 12 cranial nerves are affected by compression, inflammation or other abnormalities.
Cranial nerves emerge directly from the brain and are critical for facial movement, sensation, reflexes, vision and hearing.
Many different diseases or injuries can affect the cranial nerves. Symptoms vary depending on which particular nerve is affected. Two common syndromes include:
- Trigeminal neuralgia, which occurs when the 5th cranial nerve is compressed
- Hemifacial spasm, which occurs when the 7th cranial nerve is compressed.
Trigeminal neuralgia
Trigeminal neuralgia is a chronic pain condition that creates sudden, short attacks of severe facial pain, which may occur repeatedly throughout the day.
This pain is neuropathic (nerve-related). It centres on the trigeminal nerve (5th cranial nerve), which provides sensation and nerve signals to parts of the head and face.
Key symptoms include:
- Intense facial pain, often triggered by touching a certain spot during everyday activities like brushing your teeth, eating or blowing your nose
- Frequent, sudden bursts of pain lasting from a few seconds to a couple of minutes
- Pain typically on one side of the face only, usually affecting the lower parts
- Recurring pain, sometimes as often as 100 times a day
Because it’s so unpredictable and frequent, trigeminal neuralgia can be quite debilitating and distressing. It’s more common in women.
There are three types of trigeminal neuralgia:
- Classic – the most common form caused by a blood vessel pressing on the root of the trigeminal nerve
- Secondary – in this type, trigeminal neuralgia is triggered by another condition such as multiple sclerosis, tumours or arteriovenous malformation
- Idiopathic – this means no clear cause can be found.
Treatment options for trigeminal neuralgia may include:
- Medications, including anticonvulsants
- Surgical procedures such as percutaneous rhizotomy, microvascular decompression (MVD) to relieve nerve compression, or stereotactic radiosurgery.
Hemifacial spasm
Hemifacial spasm involves frequent, involuntary muscle contractions on one side of the face. It usually begins around the eye and can gradually extend to other areas like the cheek or mouth.
Key symptoms:
- Twitching or spasms on one side of the face, often starting around the eye.
- Progressive involvement of other facial muscles.
- Symptoms may worsen with stress or fatigue.
Hemifacial spasm may be caused by a:
- Blood vessel compressing the 7th cranial nerve
- Nerve injury
- Tumour.
Sometimes, no cause can be found. You may notice that hemifacial spasms happen more often if you’re tired, stressed or anxious.
Treatment for hemifacial spasm may include:
- Botox injections to temporarily relax the muscles and reduce spasms
- Surgery to address the underlying nerve compression.
Diagnosing cranial nerve syndromes
To diagnose cranial nerve syndromes like trigeminal neuralgia or hemifacial spasm, your doctor may:
- Ask about your medical history
- Discuss your symptoms and triggers
- Conduct a neurological examination to assess your nerve function
- Order imaging tests like an MRI or CT scan to detect nerve compression, vascular abnormalities, or other structural issues.
How can we help?
At Macquarie Neurosurgery and Spine, we offer comprehensive care for cranial nerve syndromes, using advanced diagnostic tools and treatment techniques. Our goal is to help relieve your symptoms and improve your quality of life.
Book an appointment today.
Disclaimer
All information is general and not intended as a substitute for professional advice. Macquarie Neurosurgery and Spine can consult with you regarding your individual health needs. Any surgical or invasive procedure carries risks.
All information is general and is not intended to be a substitute for professional medical advice. Macquarie Neurosurgery and Spine can consult with you to confirm if a particular treatment or procedure is right for you. Any surgical or invasive procedure carries risks. A second opinion may help you decide if a particular treatment is right for you.
References
- MSD Manuals, Overview of the cranial nerves, https://www.msdmanuals.com/home/brain-spinal-cord-and-nerve-disorders/cranial-nerve-disorders/overview-of-the-cranial-nerves, [Accessed 18 December 2024]
- MSD Manuals, Trigeminal neuralgia, https://www.msdmanuals.com/home/brain-spinal-cord-and-nerve-disorders/cranial-nerve-disorders/trigeminal-neuralgia, [Accessed 18 December 2024]
- National Institute of Neurological Disorders and Stroke, Trigeminal neuralgia, https://www.ninds.nih.gov/health-information/disorders/trigeminal-neuralgia, [Accessed 18 December 2024]
- National Institute of Neurological Disorders and Stroke, Hemifacial spasm, https://www.ninds.nih.gov/health-information/disorders/hemifacial-spasm, [Accessed 18 December 2024]
- Mayo Clinic, Hemifacial spasm, https://www.mayoclinic.org/diseases-conditions/hemifacial-spasm/symptoms-causes/syc-20373296, [Accessed 18 December 2024]
- Handbook of Skull Base Surgery (Thieme, New York, 2016) (Di Ieva A. et al), Chapter 22
