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Facial Pain

Trigeminal Neuralgia (Tic Douloureux)

Trigeminal neuralgia is a general term referring to facial pain caused by a disturbance of the Trigeminal nerve ( V cranial nerve). There are many causes of trigeminal neuralgia with variable patterns of facial pain. Tic Douloureux is a specific form of trigeminal neuralgia with a unique pattern of pain. The trigeminal nerve has three branches that go to the forehead, cheek, and jaw, and the painful condition can exist in one or all of these areas.


The pain consists of intermittent episodes of severe facial pain, lasting anywhere from a few seconds to a few minutes, with periods of no pain at all. The pain can be elicited by facial stimulation, chewing, or talking, or may occur spontaneously.


Several known causes exist, including small, benign tumors that compress the nerve adjacent to the brain stem; multiple sclerosis (usually in younger patients); or simply changes in the arterial positioning that are a natural part of aging. As our arteries become more elongated and meandering with age, the superior cerebral artery can begin to impinge on the 5th cranial nerve. In these cases, a procedure known as Microvascular Decompression (MVD) can be beneficial, with the advantage of preserving facial sensation. Other techniques include various methods by which the nerve is partially damaged to stop the painful transmissions. Radiosurgery is now an option for treatment of Tic Douloureux and has had excellent success.

Hemifacial Spasm

Hemifacial spasm is a disorder manifested by involuntary contractions of the facial muscles. It typically only involves one side of the face an may affect part or all of the facial muscles. Most patients have thythmic contractions of the muscles around the eye resulting in partial closure of the eyelid. The contractions may spread to the muscles of the cheek and mouth causing a drawing sensation in the face.

This problem occurs due to irritation of the VII cranial nerve near the brain stem. Rarely the irritation is due to a benign tumor at the base of the skull. More commonly it is caused by a loop of an artery wedged under the nerve. The rhythmic muscle contractions appear to be due to the rhythmic pulsations of the artery against the nerve.


Hydrocephalus, sometimes called “water on the brain,” is a condition where the circulation of spinal fluid within the ventricular system is obstructed or interrupted in some fashion. There are many causes for hydrocephalus. In most cases, hydrocephalus is treated by a procedure known as a ventriculo-peritoneal shunt.

Communicating Hydrocephalus

The cerebrospinal fluid is produced within the ventricular system and is reabsorbed into the bloodstream through specialized veins between the brain and skull. Communicating hydrocephalus occurs when the fluid reabsorption system fails and the ventricles begin to enlarge.

Obstructive Hydrocephalus

Obstructive hydrocephalus occurs when one or more of the ventricles become blocked or trapped by obstructions such as a tumor, cyst, or scarring from infection.

Normal Pressure Hydrocephalus (NPH)

Normal pressure hydrocephalus is a condition seen in elderly patients who develop a triad of symptoms consisting of dementia, gate disturbance known as ataxia, and bladder incontinence. These symptoms typically occur over a relatively short period of time (a few months) and can be successfully treated by a shunting procedure.