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 |