Table 3.
Summary of surgical procedures for 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 |