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The neurosurgical treatment of craniofacial pain syndromes: current surgical indications and techniques

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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Funding

This work was supported by IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy.

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Correspondence to Andrea Franzini.

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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, 159–168 (2019). https://doi.org/10.1007/s10072-019-03789-4

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Keywords

  • Trigeminal neuralgia
  • Glossopharyngeal neuralgia
  • Occipital neuralgia
  • Cluster headache
  • Migraine
  • SUNCT
  • SUNA
  • Microvascular decompression
  • Deep brain stimulation
  • Occipital nerve stimulation