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Functional neurosurgery · London

Trigeminal neuralgia, treated by the right hands.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private trigeminal neuralgia treatment costs in London.

Indicative ranges across our partner consultants and hospitals.

Procedure Indicative range
Neurosurgery consultation and MRI review £250–£450
3T MRI brain with FIESTA/CISS neurovascular protocol £650–£1,100
Microvascular decompression (MVD, Jannetta) £22,000–£38,000
Percutaneous glycerol rhizolysis £8,500–£14,000
Percutaneous balloon compression £10,000–£16,000
Percutaneous radiofrequency thermocoagulation £9,500–£15,000
Stereotactic radiosurgery (Gamma Knife or CyberKnife) £14,000–£22,000

Prices vary by hospital, by consultant and by inpatient stay. Insurance frequently funds trigeminal neuralgia treatment when medically indicated.

The journey

From first attack to lasting relief — what happens, in order.

One team from first message to medication wean and long-term follow-up.

  1. 03

    Before

    Neurosurgery consultation

    Face-to-face or video review of imaging, examination, medication history and a frank conversation about MVD versus percutaneous versus radiosurgery.

  2. 04

    On the day

    Admission and procedure

    MVD is a posterior-fossa craniotomy under general anaesthetic. Percutaneous procedures and Gamma Knife are day-case or overnight, usually under short sedation or LA.

  3. 05

    On the day

    The intervention itself

    MVD: 2–3 hours, a Teflon pledget placed between artery and root entry zone. Percutaneous: 30–60 minutes at the Gasserian ganglion. Radiosurgery: single fraction to the cisternal segment.

  4. 06

    On the day

    Recovery on the ward

    MVD: 3–5 nights, HDU overnight. Percutaneous: same-day or one-night discharge. Gamma Knife: home the same afternoon with the frame removed.

  5. 07

    After

    Follow-up and medication wean

    MVD and percutaneous: pain relief often immediate; carbamazepine tapered over weeks. Radiosurgery: onset delayed 4–6 weeks, occasionally up to 6 months.

When intervention helps

When a procedure is the right step — and when it is not.

The patterns we see most in TN clinic, plus the red flags that mean we look further before offering a procedure.

  • Classical TN with a normal exam

    Paroxysmal electric-shock pain in V2 or V3, triggered by light touch, chewing, cold air or brushing teeth. A normal neurological exam is the rule.

  • V1 or bilateral pain — think secondary

    Isolated V1 pain, bilateral symptoms, sensory loss or a young patient should prompt a search for MS plaques, a schwannoma or another secondary cause.

  • Neurovascular conflict on 3T MRI

    A loop of the superior cerebellar artery, or a vein, indenting the root entry zone (REZ) of the fifth nerve. The imaging correlate that makes MVD the durable option.

  • Medication failure or intolerance

    Breakthrough attacks on carbamazepine 800–1200 mg, or intolerable drowsiness, ataxia, rash or hyponatraemia. Time to discuss a procedure.

  • Recurrence after a previous procedure

    Pain returning years after a percutaneous procedure or radiosurgery. Options include repeat percutaneous, radiosurgery or a first-time MVD.

  • MS-related TN

    Around 2–4% of MS patients develop TN from a demyelinating plaque at the REZ. MVD is usually not appropriate; percutaneous or radiosurgery is preferred.

  • Older or frailer patients

    Where a posterior-fossa craniotomy carries more risk, a percutaneous ganglion procedure or Gamma Knife is often the better first move.

  • Red flag: constant background ache, sensory loss

    A dull constant ache, numbness, weakness of chewing or a facial motor sign points away from classical TN and towards a tumour or another cause.

Procedure options

Six ways to treat trigeminal neuralgia — plus getting the medicine right first.

What each option actually involves, and which fits which patient. For MS-related TN, percutaneous or radiosurgery is usually preferred over MVD.

  • Microvascular decompression (MVD)

    Jannetta procedure. A small retromastoid craniotomy, the offending vessel is lifted off the root entry zone and a Teflon pledget interposed. Around 90% initial pain relief and 80% at 10 years — the most durable option.

  • Glycerol rhizolysis

    A needle into the trigeminal cistern under fluoroscopy, sterile glycerol injected to injure the ganglion selectively. Quick, well tolerated, meaningful sensory loss less common than with RF.

  • Balloon compression

    A Fogarty balloon inflated in Meckel’s cave under fluoroscopy for 60–90 seconds. Useful for V1 pain because it selectively spares the corneal reflex fibres less than other percutaneous techniques.

  • Radiofrequency thermocoagulation

    A needle at the Gasserian ganglion, controlled heat lesions to the divisions producing pain. Highly effective, most likely of the percutaneous options to cause some numbness.

  • Gamma Knife radiosurgery

    A single ~80 Gy dose to the cisternal trigeminal segment through a stereotactic frame. Non-invasive, 65–85% pain relief, onset delayed 4–6 weeks.

  • CyberKnife radiosurgery

    A frameless linear-accelerator alternative to Gamma Knife with a thermoplastic mask. Comparable outcomes, no pin fixation, longer treatment time.

  • Medical therapy first

    Carbamazepine or oxcarbazepine remain first line; lamotrigine, gabapentin, pregabalin and baclofen are useful add-ons or alternatives. A properly documented trial is a prerequisite for any procedure.

  • Second-opinion review

    A specialist neurosurgical review of your MRI, medication history and prior procedures — sometimes the answer is a different drug regime or a different technique, not another operation.

London centres we work with

A short list of London units that treat TN week in, week out.

Introductions are made privately once we understand your case.

  • National Hospital for Neurology and Neurosurgery (UCLH Private)

    Queen Square — the UK reference centre for functional neurosurgery, MVD and percutaneous procedures.

  • King’s College Hospital Neurosurgery (Private Care)

    High-volume MVD and percutaneous ganglion procedures, with on-site neuro-ophthalmology.

  • HCA The Wellington Neurosurgery

    Consultant-led MVD and percutaneous options in a private tertiary setting.

  • Cleveland Clinic London

    Functional neurosurgery service with rapid MRI, consultation and theatre access.

  • Imperial Private Healthcare (Charing Cross)

    Neurosurgery service with links to the skull-base and neuro-oncology MDTs.

  • Amethyst Gamma Knife Centre, Queen Square

    Dedicated Gamma Knife unit for functional radiosurgery including TN.

  • Functional neurosurgeons with dedicated trigeminal neuralgia practices

  • Access to 3T FIESTA/CISS MRI for neurovascular conflict imaging

  • Both cranial (MVD) and percutaneous ganglion pathways in one team

  • Gamma Knife or CyberKnife referral for radiosurgery when appropriate

Safety and recovery

The risks, quoted honestly.

Every technique has trade-offs. What matters is that they are set out clearly before you consent.

  • General anaesthetic and craniotomy risks (MVD)

    Bleeding, infection, CSF leak, stroke and cerebellar injury are quoted at low single-figure percentages in high-volume hands. Discussed in detail at consent.

  • Hearing loss after MVD

    Around 1–3% risk of ipsilateral hearing impairment because the eighth nerve sits next to the operative field. Intra-operative BAER monitoring reduces the risk.

  • Facial numbness after percutaneous procedures

    Some sensory loss is expected and often part of the therapeutic effect. Bothersome numbness or anaesthesia dolorosa is uncommon but permanent when it happens.

  • Corneal reflex and keratitis

    V1 procedures can blunt the corneal reflex — protective lubricants, a bedside eye check, and early ophthalmology if the eye feels dry or gritty.

  • Delayed onset after radiosurgery

    Gamma Knife and CyberKnife work by inducing a controlled lesion in the nerve. Pain typically eases from four to six weeks, so short-term medication cover is planned.

  • Recurrence over years

    Every technique has a recurrence curve. MVD is the most durable; percutaneous and radiosurgery are more likely to need a repeat at 5–10 years — but are less invasive to repeat.

  • Medication side effects during the wean

    Carbamazepine is not stopped abruptly. A structured taper over weeks avoids rebound pain and monitors sodium, LFTs and mood.

  • MS-related TN caveats

    When the lesion is a demyelinating plaque rather than a vessel loop, MVD rarely helps. Percutaneous procedures and radiosurgery remain effective but recurrence rates are higher.

  • Red flags after discharge

    Severe headache with vomiting, clear fluid from the nose or ear, new weakness, a red painful eye or fever — call the unit or attend A&E the same day.

Reading your neurosurgery letter

Your TN work-up in four parts. Read the last one first.

  1. 01 Header

    Diagnosis, division and duration

    Classical or secondary TN, which divisions (V1/V2/V3), side, duration of symptoms and dominant triggers.

  2. 02 Imaging

    3T FIESTA/CISS findings at the REZ

    Whether a neurovascular conflict is demonstrated, which vessel, whether there is distortion or atrophy of the root, and whether secondary causes are excluded.

  3. 03 Decision

    Technique offered and why

    MVD versus percutaneous versus radiosurgery, with the reasons — age, MRI findings, MS status, previous procedures and patient preference.

  4. 04 Impression

    Expected outcome, wean and follow-up

    Read this first: expected pain relief, sensory change, medication wean plan and the follow-up schedule.

Recognised by major UK insurers

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Cover for MVD, percutaneous procedures and radiosurgery is usually funded when medically indicated.

Frequently asked

Everything we get asked about TN treatment.

Quick answers on MRI, medications, MVD versus radiosurgery, and what recovery looks like.

  • What is trigeminal neuralgia?

    A pain syndrome of the fifth cranial nerve. Sudden, unilateral, electric-shock-like pains lasting seconds, most often in the V2 (cheek) and V3 (jaw) territories, triggered by light touch, brushing teeth, chewing, wind or cold. Between attacks the face is normal. Most classical cases are caused by a small artery pressing on the nerve at the root entry zone.

  • Which MRI do I need?

    A 3T MRI brain with a thin-slice, high-resolution constructive interference sequence — FIESTA on GE, CISS on Siemens, DRIVE on Philips. This shows the trigeminal nerve and any vessel indenting the root entry zone, and rules out secondary causes such as an MS plaque or a schwannoma.

  • Should I try medication first?

    Yes. Carbamazepine and oxcarbazepine are first-line and control pain in most patients initially. Lamotrigine, gabapentin, pregabalin and baclofen are useful add-ons or alternatives. Procedures are considered when medications fail, cause intolerable side effects or lose their effect over time.

  • MVD, percutaneous or Gamma Knife — which is best?

    MVD gives the highest chance of long-term pain relief (around 90% initially and 80% at 10 years) but is a posterior-fossa craniotomy. Percutaneous procedures are quick, low-risk and repeatable but tend to cause some numbness. Gamma Knife and CyberKnife are non-invasive with delayed onset. The right choice depends on your age, MRI findings, MS status and preferences.

  • How much does private treatment cost in London?

    A consultation is £250–£450, an MRI £650–£1,100, MVD £22,000–£38,000, percutaneous ganglion procedures £8,500–£16,000 and Gamma Knife or CyberKnife £14,000–£22,000.

  • What happens after Gamma Knife — why is there a delay?

    Radiosurgery works by inducing a controlled injury in the trigeminal nerve. That takes time to develop, so pain relief typically starts at four to six weeks and can continue improving for months. Carbamazepine is continued during this window and slowly reduced once attacks settle.

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