Orange Park Medical Center - February 18, 2021

Cranial nerve disorders affect the connections between cranial nerve centers within the brain. There are 12 pairs of cranial nerves that lead directly from the brain to various parts of the head, neck and trunk. Some of the cranial nerves are involved in senses, such as seeing, hearing and taste. Others control muscles in the face or regulate glands.

Cranial nerve disorders can cause a variety of symptoms, including:

  • Intermittent attacks of excruciating facial pain
  • Vertigo (dizziness)
  • Hearing loss
  • Weakness
  • Paralysis
  • Facial twitch

“Because cranial nerve disorders are often difficult to treat, we incorporate a wide range of therapies/surgeries to identify the most effective treatment for you,” said Dr. Michael Horowitz of First Coast Neurosurgery.

Dr. Horowitz provides diagnosis and treatment for the following cranial nerve disorders:

Geniculate Neuralgia

Geniculate neuralgia is a condition that is caused by a small nerve being compressed by a blood vessel. This results in severe, deep ear pain which is usually sharp—often described as an "ice pick in the ear"—but may also be dull and burning. Ear pain can also be accompanied by facial pain. This pain can be triggered by stimulation of the ear canal, or can follow swallowing or talking.

Doctors will typically prescribe treatment with medication before recommending surgery. If surgery is required, microvascular decompression is a surgical procedure that relieves abnormal compression of a cranial nerve.

Glossopharyngeal Neuralgia

Glossopharyngeal neuralgia is characterized by a sharp, jabbing pain deep in the throat, or in the tongue, ear, and tonsils, lasting a few seconds to a few minutes. It is generally caused by a small blood vessel that presses on the nerves as they exit the brainstem. This condition is caused by irritation of the ninth cranial nerve by a blood vessel, and is most commonly seen in people over age 40.

Before recommending surgery, doctors will typically prescribe medicine to treat glossopharyngeal neuralgia. If you do require surgery, your neurosurgeon may perform microvascular decompression.

Hemifacial Spasm

Hemifacial spasm, also known as a facial twitch, is characterized by frequent involuntary twitching of one side of the face. This twitching or spasm usually starts around the eye and slowly progresses to involve the lower face. Muscles in the forehead and neck are usually the last to be affected.

Several factors may cause hemifacial spasms:

  • A blood vessel pressing on a facial nerve
  • Injury to the facial nerve
  • Bell's Palsy
  • A tumor placing pressure on the facial nerve

The most common cause of hemifacial spasm is excessive pressure on the facial nerve by the anterior inferior cerebellar artery, where the nerve begins in your brainstem. This pressure causes the nerve to misfire and make your facial muscles contract and spasm.

Occipital Neuralgia

Occipital neuralgia is a distinct type of headache characterized by sudden and recurring jabs of piercing, throbbing, chronic pain. The pain originates from base of the skull and often radiates to the back, front, and side of the head. It may also be present behind the eyes, in the upper neck, back of the head, and behind the ears, usually on one side of the head. It usually causes extreme light sensitivity to the eyes. The pain is caused by irritation or injury to the occipital nerves.

Occipital neuralgia is typically treated nonsurgically, with the goal of alleviating the pain.

Depending on the person, doctors may offer several possible approaches to relieve pain, such as:

  • Physical therapy
  • Massage
  • Pain medications

If these treatments are unsuccessful, occipital neuralgia can be treated surgically.

Trigeminal Neuralgia

Trigeminal neuralgia is a chronic condition affecting the trigeminal nerve, which is responsible for carrying sensation from your face to your brain. This condition can produce sudden, severe, shock-like feelings of pain along the face. It is caused by a blood vessel compressing the trigeminal nerve. Those with this condition may experience excruciating pain while performing seemingly simple activities, like washing their face or brushing their teeth.

The trigeminal nerve has three sections, which affect:

  • The forehead and eye region
  • The cheek
  • The jaw

Blood-vessel compression of the trigeminal nerve causes trigeminal neuralgia. Pain from trigeminal neuralgia may be triggered by activities that involve stimulating the face:

  • Laughing
  • Chewing
  • Brushing teeth
  • Talking
  • Wind
  • Facial touching

It can occur in one or all areas, though symptoms usually begin on one side of the face, and affect both sides in about 5 percent of people.

Trigeminal neuralgia is first treated medically before surgery is considered as a treatment option. If medication is not effective, neurosurgeons usually recommend microvascular decompression. This minimally invasive surgery treats the cause of the problem, offers the most long-lasting relief, and minimizes risk of postoperative side effects like numbness.

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