Neurosurgical treatment of facial neuralgias and neuropathic pain of the face

Current neurosurgical techniques for the treatment of facial neuralgias and facial neuropathic pain are reviewed. Surgical treatment is indicated when pharmacological therapy fails. There is a wide variety of procedures: percutaneous, open surgery, ablative and neuromodulation. The advantages and disadvantages of each technique are discussed. Pain can be controlled in 90% of patients with trigeminal or glossopharyngeal neuralgia by means of surgical procedures. Surgery is less frequently indicated in those patients with cluster headache or geniculate neuralgia; pain control is achieved in only 60% of these patients. Neuromodulation, percutaneous stimulation of the gasserian ganglion and motor cortex stimulation are the treatments of choice in facial neuropathic pain. The results of pain control and morbidity are reviewed for each surgical procedure.