Abstract
Craniofacial pain syndromes are comprised of multiple pathological entities resulting in pain referred to the scalp, face, or deeper cranial structures. In a small subset of patients affected by those syndromes, pharmacological and physical therapies fail in alleviating pain. In some of those refractory patients surgical procedures aimed at relieving pain are indicated and have been adopted with variable results and safety profiles. In this review, the authors describe craniofacial pain syndromes that most commonly fail to respond to pharmacological therapies and may be amenable to tailored surgical procedures. In particular, trigeminal, glossopharyngeal, and occipital neuralgias are considered, as well as some primary headache syndromes such as cluster headache, short unilateral neuralgiform headache with conjunctival injection and tearing/short unilateral neuralgiform headache with autonomic symptoms, and migraine. Surgical techniques, including the implantation of deep brain or peripheral nerve electrodes with subsequent chronic stimulation, microvascular decompression of neurovascular conflicts, and percutaneous lesioning of neural structures are described. Finally, surgical indications, outcomes, and safety of these procedures are presented.
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Abbreviations
- TN:
-
Trigeminal neuralgia
- GN:
-
Glossopharyngeal neuralgia
- ON:
-
Occipital neuralgia
- REZ:
-
Root entry zone
- MVD:
-
Microvascular decompression
- CPA:
-
Cerebellopontine angle
- SRS:
-
Stereotactic radiosurgery
- LINACs:
-
Linear accelerators
- MRI:
-
Magnetic resonance imaging
- ONS:
-
Occipital nerve stimulation
- GON:
-
Greater occipital nerve
- CH:
-
Cluster headache
- DBS:
-
Deep brain stimulation
- SUNCT:
-
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing
- SUNA:
-
Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms
- CM:
-
Chronic migraine
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This work was supported by IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy.
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Franzini, A., Moosa, S., D’Ammando, A. et al. The neurosurgical treatment of craniofacial pain syndromes: current surgical indications and techniques. Neurol Sci 40 (Suppl 1), 159–168 (2019). https://doi.org/10.1007/s10072-019-03789-4
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DOI: https://doi.org/10.1007/s10072-019-03789-4