As co-director of the Johns Hopkins Trigeminal Neuralgia Surgery Center, Judy Huang works with her team to tailor treatments and disease management plans to each patient. Refining this individualized care is what guides her and her colleagues’ research and helps make the center a top destination for treatment of trigeminal neuralgia (TN).

“Our research really focuses on trying to match the right patient with the right treatment, and the only way to know that is to examine our extensive experience in treating these patients,” she says. “That’s what drives us.”

Huang and her colleagues, including Chetan Bettegowda, director of the Department of Neurosurgery and co-director of the center, offer rhizotomy, microvascular decompression and stereotactic radiosurgery as surgical options.

The team’s recent research, described below, looks at ways to optimize treatment for individual patients from a number of angles and establishes what is likely the first mouse model for TN. Huang says the team is on the frontier of developing new ways of managing TN and expanding treatment options for patients, who have sometimes lived for many years with debilitating pain.

“We’re really committed to understanding this disease better and to refining our treatments in a very individualized, tailored approach for each patient,” Huang says. “This is a terrible disease, and we feel privileged that people seek us out, and we really do our best to match patients with the ideal solution that meets their needs.”

(For the following research, cerebrovascular and endovascular neurosurgeon Risheng Xu is senior author, and Huang, Bettegowda and fellow neurosurgeon Christopher Jackson are co-investigators unless otherwise noted).

Preoperative Opioid Use and Post-Surgery Outcomes

A study published in May in Clinical Neurology and Neurosurgery looked at preoperative opioid use and patients’ postoperative outcomes after primary percutaneous glycerin rhizotomy. Patients who had preoperative opioid use and underwent the outpatient procedure — in which a needle is passed through the cheek to inject glycerin into the place where the nerve leaves the skull in order to stun the pain-causing nerve fibers — were found to have less success getting their pain under control after surgery.

This builds upon a 2024 study published in Neurosurgery in which the team found similar results in patients with preoperative opioid use who underwent microvascular decompression, a minimally invasive surgery performed under general anesthesia that separates the nerve from any blood vessel rubbing against it.

“So now we’re able to predict that preoperative opioid use is associated with worse control of pain after surgery for either procedure,” Huang says.

Frailty and Surgery

Another study, published in September 2025 in Neurosurgical Focus, looked at the association of frailty with worse pain outcomes in older patients treated with primary percutaneous glycerin rhizotomy. As people live longer, understanding how older patients respond to surgeries is important, Huang says. The study, which reviewed 231 patients 60 and older who underwent the procedure, found that frail patients had greater postoperative pain levels and a higher incidence of rhizotomy failure compared with their counterparts who were not frail.

Huang says this underscores the importance of considering frailty status prior to surgery, noting that patients and clinicians need to understand the impact concurrent medical conditions can have on the success of surgery.

“What I would draw from that is, if somebody has a problem [related to trigeminal neuralgia], it’s better not to put off surgical options too long,” she says.

Medication vs. Surgery

TN patients go through periods of remission and relapse. Some patients put off having surgery in hopes of entering remission, and use medication to help control facial pain. A study with Bettegowda as senior author, also published in September 2025 in Neurosurgical Focus, found that prolonged medication use does not diminish the effectiveness of rhizotomy in relieving symptoms. The majority of patients included in the study (78.7%) were taking anticonvulsant medications for pain.

“It’s very optimistic,” Huang says. “It keeps options open, so even if somebody is very resistant to the idea of surgery, it doesn’t exclude them from achieving pain relief if they eventually decide to have surgery.”

Radiofrequency and Rhizotomy

TN patients may undergo multiple rhizotomy procedures due to pain recurrence, so the team researched how radiofrequency thermocoagulation (an outpatient, minimally invasive procedure that targets the nerve with a forced burst of heat) with radiofrequency and glycerin rhizotomy (RFTC-GR) or glycerin rhizotomy (GR) alone in repeat procedures influenced postoperative pain and numbness.

Published in September 2025 in Neurosurgical Focus, the study found that RFTC-GR caused greater postoperative numbness than GR alone, while reducing the risk of rhizotomy failure compared with GR alone. The numbness caused by the combined procedures is usually temporary, Huang says. If there is minimal preoperative numbness, RFTC-GR could be more appropriate, the study says.

Assessing Imaging with Machine Learning

Using magnetic resonance imaging of 183 patients undergoing microvascular decompression, the team at the TN Center successfully conducted a proof-of-concept study, published in July in Pain, in which they trained and evaluated nnU-Net, a machine learning tool designed for biological image segmentation. In the study, nnU-Net generated 3D segmentations of the trigeminal nerve region, from which clinicians can extract quantitative metrics such as surface area of neurovascular compression and correlate them with postoperative pain outcomes.

“We have so much data that we generate from radiology, and from intraoperative monitoring, for instance, and there’s a lot of patient data being gathered just in our daily practice, and we are only using a fraction of what’s available,” Huang says. “We’re really trying to expand our horizons in using more of the data that we have to achieve better patient outcomes.”

A Mouse Model for TN

The research team led by Xu successfully created a mouse model of classical TN in humans via intradural compression of the trigeminal nerve in mice. Published in December 2025 in The Journal of Headache and Pain, this may be the first such mouse model, Huang says. It will allow researchers to test novel therapies and conduct mechanistic studies in the future, opening the door to more discoveries to counter this disorder.

Medically reviewed by Judy Huang, M.D.