Headache and facial pain are a commonly encountered wide spectrum of complex medical conditions. Unfortunately, aside from treating trigeminal neuralgias, interest in surgical management of facial pain and headache from the neurosurgical community has been historically low. The reasons for this are multifactorial and include waning reimbursement, lack of evidence to support a number of pain procedures, and the absence of pain education in neurosurgical residency programs. In this article, we present surgical therapies currently available for headache and facial pain and review the published evidence for commonly performed neurosurgical treatments for craniofacial pains.


Trigeminal neuralgia (TN) is one of the many types of facial pain syndromes, which has a good evidence-based data for the benefit of surgical management. It is also one of the common conditions treated with microvascular decompression (MVD), internal neurolysis (IN), radiofrequency (RF) rhizotomy, glycerol rhizotomy, and gamma knife radiosurgery (GKRS). TN is thought to occur as a result of compression of the root entry zone of the nerve by the neighboring offending artery igniting the hyper-excitable axons at the trigeminal root.1,2 In contemporary neurosurgery, the first line of management for patients suffering from this debilitating disease is medical treatment with carbamazepine or gabapentin. In cases of failed medical therapy or drug intolerance, or simply when patients do not prefer to take these medications for a long period of time, surgical options should be considered. Neurosurgical management of TN include three modalities: craniotomy for MVD or IN, percutaneous techniques, and GKRS. Percutaneous techniques can be further divided into glycerol rhizotomy, balloon compression, and radiofrequency rhizotomy.

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