Published: July 24, 2026 | Updated: August 5, 2026
A 43-year-old woman presented to the Norton Neuroscience Institute Face Pain Clinic with severe trigeminal neuralgia pain affecting the left side of her face. She described the pain as sharp, electrical, and shock-like — triggered by everyday activities such as eating, speaking, applying makeup and exposure to cold air. The condition progressively had consumed her quality of life: She lost approximately 30 pounds between the holiday season and her clinic visit, as eating reliably triggered excruciating episodes. She had grown increasingly withdrawn, was hypervigilant about her pain management medication schedule and was reluctant to leave her home without pain management pills. She had begun exhibiting signs of significant psychological distress — a recognized pattern in trigeminal neuralgia patients. This condition at one time was known as “the suicide disease” for the profound toll uncontrolled chronic pain can exact on patients.
Trigeminal neuralgia is a clinical diagnosis confirmed by a constellation of findings: characteristic shock-like, triggered, unilateral facial pain; response to nerve-stabilizing medications; and, in appropriate candidates, radiographic evidence of neurovascular conflict. In this patient’s case, MRI imaging confirmed that a blood vessel — a looping artery — was directly compressing the trigeminal nerve at the skull base, producing the classic pattern of facial pain.
The patient had already attempted medical pain management. While an adjusted medication regimen provided partial, temporary relief, pharmacologic therapy cannot resolve the underlying anatomical issue. No amount of medication can physically move a compressive artery and effectively stop a pain signal. The disease is, in essence, a mechanical problem: a vessel impinging on a nerve, causing the nerve’s insulating sheath to break down and short-circuit, converting benign sensory signals into severe pain. There are other ways to treat this condition, including radiation therapy, balloon rhizotomy, and radiofrequency ablation, however, the multidisciplinary team determined that a microvascular decompression (MVD) procedure was the best option for this patient. With a clear structural cause identified on imaging and failed medical therapy documented, the patient did meet criteria for surgical treatment.
The primary challenge was not the diagnosis but the severity of her functional decline and the risks inherent in posterior fossa surgery, which include hearing loss, facial weakness, stroke and the rare but real possibility of not waking from anesthesia.
The patient underwent MVD, a craniotomy-based procedure performed at the skull base through a small opening behind the ear. Under high magnification, the surgical team identified the offending artery compressing the trigeminal nerve and confirmed intraoperatively that the nerve bore a visible indentation at the point of contact — direct evidence of chronic compression. The artery was carefully moved away from the nerve, and a small Teflon felt pad was interposed between the vessel and the nerve, cushioning the contact point and preventing recompression. The procedure was performed as part of Norton Neuroscience Institute’s multidisciplinary face pain program, which integrates neurosurgery and neurology to evaluate and manage complex facial pain patients.
Because every patient is different, a full evaluation with a face pain multidisciplinary team is important to design the best treatment option for the patient’s unique situation.
The patient was discharged on postoperative day 2. She was pain-free at discharge and had discontinued pain medication. Expected postoperative soreness related to the neck musculature was present but resolved with routine recovery. At her follow-up visit, she showed no signs of recurrent trigeminal neuralgia pain and was returning to baseline function.
Clinically, MVD offers pain relief in some patients — those with imaging-confirmed neurovascular issues, characteristic trigeminal nerve pain quality and prior medication response — with reported success rates that can approach 90% or higher in experienced centers. Unlike ablative procedures, MVD addresses the anatomical source of compression rather than intentionally damaging the nerve, preserving sensation and offering the possibility of long-term remission.