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Table 3 Summary of surgical procedures for treatment of facial pain

From: Current algorithm for the surgical treatment of facial pain

Procedure name Surgical details Current status Notes
Microvascular decompression Retromastoid craniectomy, decompression of trigeminal nerve root from offending vessel(s) Widely accepted (Jannetta procedure) Non-destructive nature Requires general anesthesia Immediate improvement of pain
Radiofrequency gangliolysis Percutaneous needle procedure; thermal destruction of trigeminal ganglion and root One of the most established options for TN Destructive procedure Intended to be very selective May be done with sedation Requires patient cooperation Immediate improvement of pain
Glycerol gangliolysis Percutaneous needle insertion; chemical destruction of trigeminal fibers Very commonly used percutaneous procedure Destructive procedure May be selective No need in general anesthesia Immediate improvement of pain
Balloon compression Percutaneous needle insertion; mechanical destruction of trigeminal fibers Commonly used percutaneous procedure Destructive procedure Non-selective May be done under general anesthesia Does nor require patient cooperation Immediate improvement of pain
Stereotactic radiosurgery Focused radiation aimed at the trigeminal nerve root Accepted treatment option Destructive procedure Non-selective No need in general anesthesia Improvement of pain may take several months
Neurectomy Surgical removal or interruption of peripheral branch of the trigeminal nerve Rarely used option Destructive procedure Highly selective Does not require general anesthesia Results in complete numbness of the area Immediate improvement of pain
Peripheral nerve stimulation Electrical stimulation of the peripheral branch of trigeminal nerve Relatively new application Non-destructive procedure Involves trial before implantation Adjustable/reversible
Motor cortex stimulation Electrical stimulation of motor cortex with electrode inserted into epidural space through small craniotomy Considered "off label" indication in the US Non-destructive procedure Requires craniotomy and general anesthesia Adjustable/reversible
Trigeminal tractotomy Percutaneous or open surgical destruction of the nucleus caudalis in the upper spinal cord Very rarely used treatment option Destructive procedure High risk of complications Immediate improvement of pain